DRUGS AND ALCOHOL: A SUITABLE CASE FOR TREATMENT
1.
Few things better demonstrate a culture gone mad than the so called ‘war on drugs.’ One might as well declare a war on hedonism.
When Marx famously described religion as the opium of the people he was not only providing a critique of religion. Indeed in the absence of religion opium, gin, vodka or cannabis become the opium of the people. Given that for all of recorded history life for the great mass of people has been nasty, brutish and short it is hardly surprising that the desire to use substances to mood alter has become embedded into almost every culture.
Given that advanced capitalism no longer promises an ever greater expansion of leisure time and improved quality of life, substituting instead of this promised Eden a 'work till you drop' ethos, it is hardly a surprise that the response should be recourse to the wine bottle or jar of happy pills. That addiction and dependency are the logical manifestation of this response is a predictable as the incoming tide.
Advanced capitalist states like the UK and US have responded to this epidemic with a twin track approach, hysteria and criminalisation.
In the UK thanks to the determined efforts of the tabloid press it has proved impossible to have a grown up debate about drugs policy; whilst in the US no politician can hope to be elected if seen to be ambivalent, let alone soft, on ‘the war on drugs.’ Indeed alone in the civilised world the US has managed to make the incarceration of drug users profitable.
The providers of private prisons in the US, concerned about the impact on their bottom line, have actively lobbied against any relaxation in the laws criminalizing drug use:
‘The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts, leniency in conviction or parole standards and sentencing practices or through the decriminalization of certain activities that are currently proscribed by our criminal laws. For instance, any changes with respect to drugs and controlled substances or illegal immigration could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities to house them.' (The Corrections Corporations of America Annual Report 2010)
There you have it, leave aside arguments against locking up people on the grounds of efficacy or morality, the main concern being the bottom line, it makes money.
II,
The problems of addiction and dependency always tend to be framed in terms of the cost to society, either in lost productivity or the cost to the health service and consequently the treasury. Lip service is paid to the personal cost, both emotional and physical,of abuse and dependency.
As to the efficacy of alcohol and other drugs as a means of social control, reducing discontent and siphoning away passions that might otherwise take political form, this is the unspoken dimension to misuse; don’t get mad get stoned. Dystopian novels such as Brave New World, ‘Soma’ or 1984, ‘Victory Gin,’ have recognised this function of drugs and alcohol.
Thus political elites have always had an ambivalent attitude toward substance misuse, fearful of its capacity to sap the work ethic and erode self control and compliance, whilst at the same time recognising the need to keep the people happy. Alcohol moreover represents ‘a nice little earner’ for most exchequers with the added advantage that the imposition of hefty alcohol duties can be presented as public health measures by 'concerned' politicians.
However from the viewpoint of governing elites believe highly addictive substances, such as heroin or crack cocaine, present a more serious threat to social cohesion than alcohol and consequently requires not only heavy legal penalties for use and supply but strong social opprobrium. This hysteria, aimed initially at opiates, was then extended to other substances such as cannabis,- on balance a less harmful drug than alcohol,- and substances such as amphetamines, which are characterised as 'gateway drugs,' the lower rungs of a ladder leading to dependency.
There is neither logic nor rationality in any of this hysteria; whipped up by a rabid media; indeed such propaganda often pushed out by journalists not averse to the occasional snort of cocaine themselves. Rational discourse about drug use not to be engaged in front of the 'children.'
The reality is that even in the most well ordered utopia people will still wish to block out uncomfortable situations and feelings such as lack of confidence, low self esteem, shyness, or to enhance feelings of well being and companionship; sometimes people will wish, out of curiosity, to explore altered states of consciousness.
In a civilised society it seems to me the role of the state/collective should be to ensure that such experiences are as safe as possible and support those who get into difficulties rather than criminalising and persecuting them.
That such an obviously sane and sensible approach is not utopian, but practical, and produces very positive outcomes which can be shown by investigating the kind of strategies adopted in places like Amsterdam and Portugal.
III.
TREATMENT, COERCION AND THE TWELVE - STEP PROGRAMME
Treatment for dependency has developed in this country less as a consequence of strategic planning but of changing attitudes, fashion and political muddle. Whatever the prevailing fashion however punitive attitudes toward problem drug and alcohol users are never very far away.
From 2003 until 2006 I was involved in the development and implementation of drug treatment intervention in the criminal justice system. This turned from an enlightened approach to drug using offenders into an insidious assault on civil liberties that crept onto the statute book unnoticed by the rest of society; drug users you see having abrogating all rights to civil liberty, no one was paying attention.
As I say it began as a benign policy, designed to keep drug users out of prison and divert them into treatment. It seemed to me humane and progressive. I had not though reckoned with the zealots of New Labour.
The Drug Intervention Programme [DIP], as it came to be called, soon began to develop along increasingly coercive lines. Originally it was envisaged that anyone arrested and charged for offences commonly associated with drug use, e.g. shoplifting, would be tested for the presence of opiates and other drugs. If found positive they would be offered treatment as an alternative to custody or other criminal sanctions. Soon however the government moved to testing on arrest,[1] it then number of ‘trigger’ offences was greatly expanded and penalties for failing to co-operate with ‘treatment,’ increasingly draconian. Thus you could be arrested on a demonstration, be forced to undertake an invasive drug test,- refusal itself being a criminal offence,- and if testing positive for, say cannabis, forced to attend ‘treatment’ interviews.
My use of inverted comma’s indicate the increasingly shoddy and slapdash nature of this treatment; provided invariably on a shoestring, almost exclusively by by the voluntary sector. I left this programme early in 2006, a time when background noise about failure to co-operate in treatment leading to such coercive measures as withdrawal of benefits or restricted access to social housing.
Unsurprisingly the current government has followed much the same course, only now with funding for greatly curtailed. There is one added dimension however, the Tories have discovered God!
It has been an open secret in the field of substance misuse that treatment is often ineffective. Even what constitutes a successful treatment outcome is a matter of dispute. The one clear cut measure of success is long term abstinence, i.e. a sustained cessation of drug and/or alcohol use. However
measured by abstinence, success rates are extremely low; recovery from drug and alcohol dependency characterised by relapse, sometimes frequent and prolonged. Abstinence is important as a measure as the evidence overwhelmingly pointing to the fact that once a person develops dependence it is extremely difficult for them to return to a purely recreational pattern of use.
So difficult has abstinence as a measure of success proved that treatment providers have constantly sought other measures to indicate successful outcomes, some more legitimate than others e.g. improved quality of life.
The one area of provision that has boasted greater levels of success, though often with little supporting evidence, has been the '12-step' approach.
It is perhaps as well to make clear that the word treatment is something of a misnomer when speaking of drug and alcohol dependency. Treatment suggestive as it is of a science, of tested and testable methodology. Drug and alcohol treatment is not like that, based as it is on a variety of ‘talking cures’- counselling, confession and confrontation. Drug based treatment is in it is infancy whilst new age quackery is ubiquitous, making large, unverified, claims for its efficacy. The reality is a hodgepodge of approaches based around group therapy. Foremost amongst these being the so called 12-Step approach.
Emerging out of, and incorporating, the approach of Alcoholics Anonymous, as it is outlined in the 'AA programme'; it’s popularity and its improved outcomes are largely a consequence of its character as a community of people seeking to remain abstinent. This formula has been copied by both drug users and those experiencing other problems of addictive/compulsive behaviour e.g. gamblers and those with eating disorders. There are now literally thousands of 12-step oriented meetings/groups [2] each week, with no part of the UK where it is impossible to locate an AA or NA (Narcotics Anonymous) meeting. 12 Step 'treatment' usually involves immersion in 12-Step culture, after which clients/patients are encouraged to regularly attend meetings.
Since meetings are openly accessible and free the attractions of this model are obvious, moreover there is an inbuilt recognition of the life-long need to remain abstinent. Meetings are, theoretically, run on democratic lines and the sense of camaraderie that can develop, mixed with the socialising that inevitably takes place with fellow members, can provide a real feeling of belonging and sense of community, absent for most people in the modern world.
There is however a shadow. The 12-Step programme is profoundly spiritual in tone; nothing in itself, of course, wrong with this; however it can also have about it many of the qualities of a cult. Given the intense religiosity of the programme this is hardly surprising. Thus the first 5 steps of the programme:-1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
These tenets, assumptions of Grand canyon proportions, are backed up by peer pressure and an atmosphere that stresses self abnegation and humility respecting the group and the programme. The emphasis is always placed on orthodoxy - the primacy of the basic texts. This 'programme' being the sole path to recovery. The unorthodox and outsiders are often belittled or demonized. All these elements can present as features of AA and the NA culture.
All of this would be of little concern to the wider public, an internal matter purely for members, but for the fact that the 12-step philosophy of treatment with its central tenet of ‘recovery’,(not only can you not drink or use other substances, but you have a lifelong 'disease' from which there is no cure, only remission, which can only be guaranteed by continued engagement with 12-Step groups), is currently being embraced by the government here, having long enjoyed the support of the medical establishment in the US.
The attractions of a 12-Step approach for a conservative are not difficult to locate. Once a short period in rehab has been completed clients get their support from the various 12 -Step ‘fellowships.’ That is, in the community, where no state funding is required,(indeed outside funding is strictly prohibited within the 12-Step philosophy). The philosophy stresses self responsibility and reliance, is inherently quiescent and conservative stressing acceptance of things as they are and decrying those who question or challenge, not just the ‘programme,’ but the way in which the world is ordered. A few AA slogans illustrate this mindset:-
I never met anyone too dumb to stay sober,
but I met lots of people who were too smart
Humility is the Key to Sobriety
Some brains need washing
Live and Let Live
Stop playing God.
Trust God, clean house, serve others
Do your best and leave the rest to God/Let go and Let God
Few things better demonstrate a culture gone mad than the so called ‘war on drugs.’ One might as well declare a war on hedonism.
When Marx famously described religion as the opium of the people he was not only providing a critique of religion. Indeed in the absence of religion opium, gin, vodka or cannabis become the opium of the people. Given that for all of recorded history life for the great mass of people has been nasty, brutish and short it is hardly surprising that the desire to use substances to mood alter has become embedded into almost every culture.
Given that advanced capitalism no longer promises an ever greater expansion of leisure time and improved quality of life, substituting instead of this promised Eden a 'work till you drop' ethos, it is hardly a surprise that the response should be recourse to the wine bottle or jar of happy pills. That addiction and dependency are the logical manifestation of this response is a predictable as the incoming tide.
Advanced capitalist states like the UK and US have responded to this epidemic with a twin track approach, hysteria and criminalisation.
In the UK thanks to the determined efforts of the tabloid press it has proved impossible to have a grown up debate about drugs policy; whilst in the US no politician can hope to be elected if seen to be ambivalent, let alone soft, on ‘the war on drugs.’ Indeed alone in the civilised world the US has managed to make the incarceration of drug users profitable.
The providers of private prisons in the US, concerned about the impact on their bottom line, have actively lobbied against any relaxation in the laws criminalizing drug use:
‘The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts, leniency in conviction or parole standards and sentencing practices or through the decriminalization of certain activities that are currently proscribed by our criminal laws. For instance, any changes with respect to drugs and controlled substances or illegal immigration could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities to house them.' (The Corrections Corporations of America Annual Report 2010)
There you have it, leave aside arguments against locking up people on the grounds of efficacy or morality, the main concern being the bottom line, it makes money.
II,
The problems of addiction and dependency always tend to be framed in terms of the cost to society, either in lost productivity or the cost to the health service and consequently the treasury. Lip service is paid to the personal cost, both emotional and physical,of abuse and dependency.
As to the efficacy of alcohol and other drugs as a means of social control, reducing discontent and siphoning away passions that might otherwise take political form, this is the unspoken dimension to misuse; don’t get mad get stoned. Dystopian novels such as Brave New World, ‘Soma’ or 1984, ‘Victory Gin,’ have recognised this function of drugs and alcohol.
Thus political elites have always had an ambivalent attitude toward substance misuse, fearful of its capacity to sap the work ethic and erode self control and compliance, whilst at the same time recognising the need to keep the people happy. Alcohol moreover represents ‘a nice little earner’ for most exchequers with the added advantage that the imposition of hefty alcohol duties can be presented as public health measures by 'concerned' politicians.
However from the viewpoint of governing elites believe highly addictive substances, such as heroin or crack cocaine, present a more serious threat to social cohesion than alcohol and consequently requires not only heavy legal penalties for use and supply but strong social opprobrium. This hysteria, aimed initially at opiates, was then extended to other substances such as cannabis,- on balance a less harmful drug than alcohol,- and substances such as amphetamines, which are characterised as 'gateway drugs,' the lower rungs of a ladder leading to dependency.
There is neither logic nor rationality in any of this hysteria; whipped up by a rabid media; indeed such propaganda often pushed out by journalists not averse to the occasional snort of cocaine themselves. Rational discourse about drug use not to be engaged in front of the 'children.'
The reality is that even in the most well ordered utopia people will still wish to block out uncomfortable situations and feelings such as lack of confidence, low self esteem, shyness, or to enhance feelings of well being and companionship; sometimes people will wish, out of curiosity, to explore altered states of consciousness.
In a civilised society it seems to me the role of the state/collective should be to ensure that such experiences are as safe as possible and support those who get into difficulties rather than criminalising and persecuting them.
That such an obviously sane and sensible approach is not utopian, but practical, and produces very positive outcomes which can be shown by investigating the kind of strategies adopted in places like Amsterdam and Portugal.
III.
TREATMENT, COERCION AND THE TWELVE - STEP PROGRAMME
Treatment for dependency has developed in this country less as a consequence of strategic planning but of changing attitudes, fashion and political muddle. Whatever the prevailing fashion however punitive attitudes toward problem drug and alcohol users are never very far away.
From 2003 until 2006 I was involved in the development and implementation of drug treatment intervention in the criminal justice system. This turned from an enlightened approach to drug using offenders into an insidious assault on civil liberties that crept onto the statute book unnoticed by the rest of society; drug users you see having abrogating all rights to civil liberty, no one was paying attention.
As I say it began as a benign policy, designed to keep drug users out of prison and divert them into treatment. It seemed to me humane and progressive. I had not though reckoned with the zealots of New Labour.
The Drug Intervention Programme [DIP], as it came to be called, soon began to develop along increasingly coercive lines. Originally it was envisaged that anyone arrested and charged for offences commonly associated with drug use, e.g. shoplifting, would be tested for the presence of opiates and other drugs. If found positive they would be offered treatment as an alternative to custody or other criminal sanctions. Soon however the government moved to testing on arrest,[1] it then number of ‘trigger’ offences was greatly expanded and penalties for failing to co-operate with ‘treatment,’ increasingly draconian. Thus you could be arrested on a demonstration, be forced to undertake an invasive drug test,- refusal itself being a criminal offence,- and if testing positive for, say cannabis, forced to attend ‘treatment’ interviews.
My use of inverted comma’s indicate the increasingly shoddy and slapdash nature of this treatment; provided invariably on a shoestring, almost exclusively by by the voluntary sector. I left this programme early in 2006, a time when background noise about failure to co-operate in treatment leading to such coercive measures as withdrawal of benefits or restricted access to social housing.
Unsurprisingly the current government has followed much the same course, only now with funding for greatly curtailed. There is one added dimension however, the Tories have discovered God!
It has been an open secret in the field of substance misuse that treatment is often ineffective. Even what constitutes a successful treatment outcome is a matter of dispute. The one clear cut measure of success is long term abstinence, i.e. a sustained cessation of drug and/or alcohol use. However
measured by abstinence, success rates are extremely low; recovery from drug and alcohol dependency characterised by relapse, sometimes frequent and prolonged. Abstinence is important as a measure as the evidence overwhelmingly pointing to the fact that once a person develops dependence it is extremely difficult for them to return to a purely recreational pattern of use.
So difficult has abstinence as a measure of success proved that treatment providers have constantly sought other measures to indicate successful outcomes, some more legitimate than others e.g. improved quality of life. The one area of provision that has boasted greater levels of success, though often with little supporting evidence, has been the '12-step' approach.
It is perhaps as well to make clear that the word treatment is something of a misnomer when speaking of drug and alcohol dependency. Treatment suggestive as it is of a science, of tested and testable methodology. Drug and alcohol treatment is not like that, based as it is on a variety of ‘talking cures’- counselling, confession and confrontation. Drug based treatment is in it is infancy whilst new age quackery is ubiquitous, making large, unverified, claims for its efficacy. The reality is a hodgepodge of approaches based around group therapy. Foremost amongst these being the so called 12-Step approach.
Emerging out of, and incorporating, the approach of Alcoholics Anonymous, as it is outlined in the 'AA programme'; it’s popularity and its improved outcomes are largely a consequence of its character as a community of people seeking to remain abstinent. This formula has been copied by both drug users and those experiencing other problems of addictive/compulsive behaviour e.g. gamblers and those with eating disorders. There are now literally thousands of 12-step oriented meetings/groups [2] each week, with no part of the UK where it is impossible to locate an AA or NA (Narcotics Anonymous) meeting. 12 Step 'treatment' usually involves immersion in 12-Step culture, after which clients/patients are encouraged to regularly attend meetings.
Since meetings are openly accessible and free the attractions of this model are obvious, moreover there is an inbuilt recognition of the life-long need to remain abstinent. Meetings are, theoretically, run on democratic lines and the sense of camaraderie that can develop, mixed with the socialising that inevitably takes place with fellow members, can provide a real feeling of belonging and sense of community, absent for most people in the modern world.
There is however a shadow. The 12-Step programme is profoundly spiritual in tone; nothing in itself, of course, wrong with this; however it can also have about it many of the qualities of a cult. Given the intense religiosity of the programme this is hardly surprising. Thus the first 5 steps of the programme:-1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
These tenets, assumptions of Grand canyon proportions, are backed up by peer pressure and an atmosphere that stresses self abnegation and humility respecting the group and the programme. The emphasis is always placed on orthodoxy - the primacy of the basic texts. This 'programme' being the sole path to recovery. The unorthodox and outsiders are often belittled or demonized. All these elements can present as features of AA and the NA culture.
All of this would be of little concern to the wider public, an internal matter purely for members, but for the fact that the 12-step philosophy of treatment with its central tenet of ‘recovery’,(not only can you not drink or use other substances, but you have a lifelong 'disease' from which there is no cure, only remission, which can only be guaranteed by continued engagement with 12-Step groups), is currently being embraced by the government here, having long enjoyed the support of the medical establishment in the US.
The attractions of a 12-Step approach for a conservative are not difficult to locate. Once a short period in rehab has been completed clients get their support from the various 12 -Step ‘fellowships.’ That is, in the community, where no state funding is required,(indeed outside funding is strictly prohibited within the 12-Step philosophy). The philosophy stresses self responsibility and reliance, is inherently quiescent and conservative stressing acceptance of things as they are and decrying those who question or challenge, not just the ‘programme,’ but the way in which the world is ordered. A few AA slogans illustrate this mindset:-
I never met anyone too dumb to stay sober,
but I met lots of people who were too smart
Humility is the Key to Sobriety
Some brains need washing
Live and Let Live
Stop playing God.
Trust God, clean house, serve others
Do your best and leave the rest to God/Let go and Let God
Now it is possible to mount a defence of this philosophy, closer to as it is to Buddhism than Christianity, and I have done so in the past. The pertinent point here though is that this quasi religion is being sold as the only effective treatment approach for addiction, and already a significant amount of public money is being used to fund patients in 12-Step oriented treatment facilities.[3] Sometimes as a consequence of patient choice, though increasingly as a result of the narrow list of approved providers being dominated by 12-Step focused treatment. However increasingly some alcohol and drug dependent people are finding themselves in 12-Step treatment as a consequence of coercion through the criminal justice route.(RAPT,for instance, the in-house prison treatment programme is 12-Step in orientation).
Immersion into such a highly controlled and rigid philosophical system,-most treatment centres place severe restrictions on personal freedom, on what books, if any are permitted, place controls on access to TV and restrictions on patients free time,where they can go and who they can socialise with,- can present as a severe shock to patients, and it requires a robust ego to maintain equilibrium. Whilst the more severe, ‘break them down/build them up’ Minnesota model, created in the US, is thankfully rare in this country, a highly coercive treatment model, quasi religious in character, has now become the dominant treatment model.
Religious fanatics, of course, have always seen addicts and alcoholics as easy prey, from the Salvation Army, to the Army of Jesus[4] and the Nation of Islam; all have sought to convert those in difficulty with drugs or alcohol. Given the degree of desperation many bottom end users experience, their emotional vulnerability and need for basic help and support, it is hardly surprising that many jump onto the lifeboat marked religion. In turn these converts tend to be both the most zealous and the most evangelical. (This kind of newcomer evangelism is mirrored in AA).
One new arrival on the religious/recovery scene is The Kings Arms Project, a new religious group established by Philippa Stroud. This extremely small charity would not be important other than the fact that Philippa Stroud is a co-founder of The Centre For Social Justice, along with our current welfare minister Iain Duncan Smith. We consequently now have a government wedded solely to the 'recovery'[5] model. God is closer to this government in this area of social policy than the public realise.
As this new found evangelical zeal enters a major area of social policy, the factors leading to drug and alcohol dependency proliferate,- economic recession leading to unemployment and poverty, with support services being drastically cut. In many areas of the country those in difficulties with drug or alcohol face the choice of either engaging with a quasi religious cult or nothing!
IV.
So what are the alternatives? Well the primary alternative to a purely abstinence based approach to alcohol or drug problems is the harm reduction approach; providing support and services for those either unable or unwilling to engage with abstinence. Such interventions support people precisely where they are on the treatment spectrum, from merely acknowledging that they may have a problem to contemplating abstinence. Many will be supported for prolonged period, some simply seeking to manage their addiction.
In a healthy treatment environment this approach would represent one point on a broad spectrum of treatment options, as I say representing for some a starting point on a continuum leading to abstinence. The reality in this country has been a form of trench warfare, with providers of both treatment orientations deriding and seeking to undermine the other. At the moment abstinence holds sway and harm reduction programmes providing alternative prescribing, e.g. methadone, needle exchanges and the management of alcohol consumption are being cut. This will have disastrous consequences for those drug users in difficulty either unready or unwilling to engage with abstinence.
At a time when belief in God is in decline and faith based healing is justifiably excluded from medical service provision we need to be asking questions about how state funded treatment came to rely so much on a treatment philosophy reliant on belief in God.
Drugs, and I always include alcohol in this category, will always be with us, people will always seek ways to artificially change their mood and some will get into difficulties sometimes they will become either physiologically and psychologically dependent.
In a grown up society it would be possible to discuss these issues coolly, calmly, with compassion and attempts at empathy; unfortunately we do not live in a grown up society.
Alex Talbot September 2013
1 A clear violation of the principle innocent until proved guilty.
2. The difference between a meeting and a group is complex, in essence all meetings are groups, however some a much smaller and intimate than others, allowing for the establishment of a small community that becomes your base or 'home' group.
3. This has been the case since Community Care Funding was introduced. Originally though 12-Step approaches were viewed as suspect and a minority treatment approach, clients however, already introduced to 12-Step meetings were attracted to the familiarity and the radical nature of the 12-Step approach.
4. How the Christians do love their military metaphors.
5. Code for an abstinence based 12-step approach.
Having visited this page I would be grateful for your feedback, either tick one of the boxes below or make a comment via the comments button.
Immersion into such a highly controlled and rigid philosophical system,-most treatment centres place severe restrictions on personal freedom, on what books, if any are permitted, place controls on access to TV and restrictions on patients free time,where they can go and who they can socialise with,- can present as a severe shock to patients, and it requires a robust ego to maintain equilibrium. Whilst the more severe, ‘break them down/build them up’ Minnesota model, created in the US, is thankfully rare in this country, a highly coercive treatment model, quasi religious in character, has now become the dominant treatment model.
Religious fanatics, of course, have always seen addicts and alcoholics as easy prey, from the Salvation Army, to the Army of Jesus[4] and the Nation of Islam; all have sought to convert those in difficulty with drugs or alcohol. Given the degree of desperation many bottom end users experience, their emotional vulnerability and need for basic help and support, it is hardly surprising that many jump onto the lifeboat marked religion. In turn these converts tend to be both the most zealous and the most evangelical. (This kind of newcomer evangelism is mirrored in AA).
One new arrival on the religious/recovery scene is The Kings Arms Project, a new religious group established by Philippa Stroud. This extremely small charity would not be important other than the fact that Philippa Stroud is a co-founder of The Centre For Social Justice, along with our current welfare minister Iain Duncan Smith. We consequently now have a government wedded solely to the 'recovery'[5] model. God is closer to this government in this area of social policy than the public realise.
As this new found evangelical zeal enters a major area of social policy, the factors leading to drug and alcohol dependency proliferate,- economic recession leading to unemployment and poverty, with support services being drastically cut. In many areas of the country those in difficulties with drug or alcohol face the choice of either engaging with a quasi religious cult or nothing!
IV.
So what are the alternatives? Well the primary alternative to a purely abstinence based approach to alcohol or drug problems is the harm reduction approach; providing support and services for those either unable or unwilling to engage with abstinence. Such interventions support people precisely where they are on the treatment spectrum, from merely acknowledging that they may have a problem to contemplating abstinence. Many will be supported for prolonged period, some simply seeking to manage their addiction.
In a healthy treatment environment this approach would represent one point on a broad spectrum of treatment options, as I say representing for some a starting point on a continuum leading to abstinence. The reality in this country has been a form of trench warfare, with providers of both treatment orientations deriding and seeking to undermine the other. At the moment abstinence holds sway and harm reduction programmes providing alternative prescribing, e.g. methadone, needle exchanges and the management of alcohol consumption are being cut. This will have disastrous consequences for those drug users in difficulty either unready or unwilling to engage with abstinence.
 |
| AA SERENITY PRAYER |
Drugs, and I always include alcohol in this category, will always be with us, people will always seek ways to artificially change their mood and some will get into difficulties sometimes they will become either physiologically and psychologically dependent.
In a grown up society it would be possible to discuss these issues coolly, calmly, with compassion and attempts at empathy; unfortunately we do not live in a grown up society.
Alex Talbot September 2013
1 A clear violation of the principle innocent until proved guilty.
2. The difference between a meeting and a group is complex, in essence all meetings are groups, however some a much smaller and intimate than others, allowing for the establishment of a small community that becomes your base or 'home' group.
3. This has been the case since Community Care Funding was introduced. Originally though 12-Step approaches were viewed as suspect and a minority treatment approach, clients however, already introduced to 12-Step meetings were attracted to the familiarity and the radical nature of the 12-Step approach.
4. How the Christians do love their military metaphors.
5. Code for an abstinence based 12-step approach.
Having visited this page I would be grateful for your feedback, either tick one of the boxes below or make a comment via the comments button.
