#NDSAG2018 – The SMART outsider’s Perspective

Beer

It’s always good to keep your mind fresh, stagnation of ideas or constrained thinking is often detrimental to productivity…

Thankfully, there are numerous resources which help me to keep up to date with current issues impacting upon my work.

One of these is the New Directions in the Study of Alcohol Group (Twitter @NDSAG) but, due to other commitments this year, I sadly missed their annual conference and presentations.

Thanks to the power of social-media (Twitter feed #NDSAG2018), I’ve been able to catch up on the discussions.

This event, attended by a varied range of academics and professionals in the field of alcohol use and misuse, looks at current thinking around research into treatment interventions and methodology.

This year’s conference theme was ‘Alcohol & Recovery’ and early in his blog, Will Haydock (see below) alluded to how the day’s content was “…arguing against the drawing of clear lines.” Immediately, I was regretful about not having been there.

Previously, my “interesting and thought provoking trip to the seaside” provided content for a blog post on the 2017 conference however; this time, I’m restricted to commenting upon the views provided by someone else.

Interestingly, this year also saw an inaugural gathering of the Addiction Theory Network, comprising of experts from many disciplines. This group (coincidentally) agrees with one of my regular personal thoughts (see here)…

We think that a sole reliance on the disease model of addiction can do harm. (Addiction Theory Network)

As a Local Authority ‘Commissioner’ of alcohol and drugs services, I usually find Will Haydock’s comments and observations (see Thinking to Some Purpose blog) useful as well as interesting. He sees issues and impacts of his work in a far more rounded manner than some of his peers. Providing opinion that is mostly devoid of any political or financial connotations, and certainly not formed from any gutter press induced perspective or direction.

Throughout the day, there were some common themes that struck me. I’m not quite sure how I can link them together coherently (or even if I should – perhaps that would be a misrepresentation) but I’m going to do my best… (Will Haydock)

Too often, many who work in this area [addictions recovery] and in particular the policy makers, are a little too quick to draw lines of robust theoretical and political demarcation. Boundaries that more often than not are formulated from academic kudos, political direction and enforced financial direction (aka budgetary constraint), rather than growing from the support needs of individual human beings. Sad but true!

In addition to this; society (mostly due to media influence) and politicians (seeking popularity) are predisposed to the lazy (but hopefully descriptive) use of labels.

The media has a problem with alcoholism – and it’s stopping people getting help. Alcoholism as a term has long expired, so why do common narratives around alcohol problems still rely on it so much? (The Guardian)

But it’s strange, the use of this stigma inducing process and terminology like ‘addiction’ services, ‘alcoholic’ and ‘alcoholism’ can also quickly be forgotten. Especially if/when individuals, who have previously craved escape from this mechanical nomenclature, are able to join their local ‘recovery’ club. That ‘in-crowd’ of achievement where usually (and justifiably) people are proud to accept their new ‘label’ of social identity… but they’re also not obliged to stay there, unless that happens to be their choice.

If we take away the idea of a defining ‘disease’, or a clearly defined group with a ‘problem’, and replace it with the idea that everyone is somewhere on a spectrum, how can there be a neat group identity? (Will Haydock)

In answer to Will’s question I would say… Why do we want and/or do we really need “a neat group identity”?

Very basically the answer has to be a resounding no, to both parts of the question. In reality, the only reason we have all these ‘labels’ and demarcation is to feed the ever-hungry organisational machine – specific ‘industry’ remits that create and perpetuate, silo thinking in the so-called ‘partnership working’ of administrative function – all to support and quantify statistical outcomes, all be it (hopefully) successful ones.

But where does the ‘human’ sit in this (too often) disjointed process, with its connected plethora of often unnecessary administration?

Yes, we do need to “take away the idea of a defining ‘disease’, or clearly defined groups with a problem”, and replace that with the idea that “everyone is somewhere on a spectrum”, sooner rather than later.

In my opinion, outcomes from current procedural considerations, formed on the back of ‘disease and cure’ outcomes have created significantly negative impacts for the ‘recovery’ goal.

What would separate someone who had stopped drinking having had a physical dependency from someone who had decided they were drinking a bit over the recommended limits? (Will Haydock)

Why would we want or need to? Shouldn’t everyone, irrespective of their individual position on this ‘spectrum’ of issues, be able to find and receive the help and support they require? Is the often used “no closed door” phrase simply a contrived and hollow marketing ploy? One that’s used to disguise failures in inter-organisational responsibility. More politically generated hot air, rather than a treatment and support reality.

Will went on to mention the relevance of the “tribes of fellowship supporters” and “those who advocate a more cognitive approach” in ‘recovery clubs’ and all are relevant to the overall [recovery] process. The ‘group-hug’ of ‘recovery’ is as much about inclusion in a social group after all, humans are a tribal social species. Escape from the isolation of stigma or guilt and shame in addictions, a factor that creates exclusion, is repaired (in part) by repairing or making social connections. And yes, even with SMART Recovery this exists, despite it usually being at less prescribed levels.

Any effective recovery from substance addictions, or any compulsive or addictive behaviour for that matter, involves the rediscovery of healthy connections, and the making of new ones. But recovery is not simply the process of, exchanging your DOC with a fixation on a process or place. Recovery is an individual journey, travelled with support. A phase in life, as with that problematic period before, one that you can and should be able to move on from. A journey and not a geographic location, a new social location that shouldn’t be seen as a permafrost of lifelong commitment …unless that happens to fit the needs or desires of the individual. It’s his/her choice.

This is also a (significant) reason why, so many people are not “signed up to a single, coherent philosophy or ideology” and the concept of long-term sustained ‘recovery’ is, and always should be, a pick-n-mix process. A journey that should always include a diverse (and available) range of treatment interventions and support methodologies.

…you can find people who step out of a therapeutic community and then go to AA meetings, despite the fact that these two approaches have quite different understandings of the nature of the problem a person is likely to be facing, and how this is best dealt with. (Professor David Best BA Hons, MSc, PhD)

Recovery is an ongoing process, something that individuals make a personal choice to engage with, irrespective of whichever particular pathway they select. Despite organisational desires to label and conveniently box up the concept of recovery; it’s also detrimental when services observe addiction purely as an illness or disease, for whatever reason. Put simply, ‘Illness’ implies ‘diagnosis’ leading to a ‘cure’ that is ‘prescribed’ and all will be OK – “I’m a victim, I got ill but give me the magic pill and bish-bash-bosh, I’m cured.

This can be (and is often) counterproductive; it dilutes personal ownership (and importantly some control) of any process in the journey of recovery.

With this in mind, support services also shouldn’t dictate pathways, or inhibit individual [informed] choice. The most successful routes to ‘sustained’ recovery are usually those where a person has enjoyed some personal and effective control of their [supported] journey.

But as so often when this comes up and people try to define it, I was struck by the universality of the concept of recovery. What I mean by this is that when people spoke about recovery, they were talking about something that could be applied to everyone’s lives, not just people with an identified ‘addiction’ or substance use disorder. (Will Haydock)

In the blog post, Will revisited his own past “facetious” hypothesis which suggested; “basically everything we study is sociology” and, our fixation about delving into the ‘science’ of any particular substance, or indeed a reason for use, is probably irrelevant… he could well be correct.

To my mind, it’s not the substance at the route of problematic consumption or indeed very often, any subsequent addictive process. That (over) use, with increasing regularity, stems from a societal event. One that lead the individual to either; attempt enhanced or heightened euphoria (for hedonistic reasons) or, to seek solace or escape from physical or psychological trauma, by way of self-medication.

As Will pointed out; David Best has previously referred to recovery as a search for ‘eudaimonia’ and suggested that it [recovery] represents “a shift from ‘hedonism’ (pleasure-seeking) to something more rounded and whole (‘eudaimonia’)” or the feeling of ‘fulfilment’ and/or ‘flourishing’… a lifelong philosophy worthy of our striving to achieve… or ‘connect’ with perhaps?

…how many of those lines [do we] really need and how permeable they ought to be… it was noted that in general there isn’t a huge need to separate men and women into gender-specific groups for treatment. (Will Haydock)

I tend to agree with this in principle but with some caveats. I believe the search for social connection (or re-connection) in recovery is best achieved within diverse and inclusive structures. Breaking those structures into sub-groups which accommodate the (mostly perceived) needs of gender, ethnicity or sexuality etc, can create additional and often unforeseen negative impacts.

If recovery is [largely] about supporting individuals to find /rediscover their [new] social position in society; wouldn’t it be better for the ‘group-hug’ to replicate our diverse society, instead of perpetuating the labels affixed to demographic sub-divisions?

In summary, Will raised some important questions at the end of his post, some of which I’m sure many of us would be happy to get answers for. One that stood out to me was; What makes recovery something specific to our ‘sector’?

A sensible observation, especially when addiction is so often born of social discord, and/or our individual reactions to [difficult] events. Perhaps it’s our society that needs a ‘cure’ not the individual?

I wonder. What makes this about alcohol? How does it relate to mental health? And how does treatment relate to housing, employment and personal relationships, which we know are so influential? And at what point does talking about developing a different way of living, a different way of organising society, stop being a discussion of alcohol treatment and policy and simply become a political project? (Will Haydock)

Surely it’s never really been about understanding the molecular structure and chemical effects of any given substance, or indeed the scientific nature or psychology of an addictions process for that matter. No, the ‘problems’ we need to understand and fix are, without a doubt, mostly societal issues. The majority of these are beyond our remit and mostly beyond our ‘repair’ capabilities as addictions specialists. We’re mostly destined to stick with understanding substances and behaviours, despite Will’s conclusion for “New Directions in the Study of Life!”

Note: Comments and opinions expressed within this post are the personal views of the author Dave Hasney, National Coordinator (England) for UK SMART Recovery, unless otherwise attributed. They are not necessarily the views of UK SMART Recovery and should not be attributed to that entity.
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