Stop Making Money from Misery

Preamble

Person ThinkingOr maybe that should be pre-ramble? Whatever… I started out with the intention of re-examining one specific subject, addiction treatment provision in this post however, I’ve expanded that subject to also include recovery support pathways (again).

As is so often the case when I’m thinking and writing at the same time, as opposed to planning beforehand, which I probably should do more often, I became increasingly interested in my thought tangents. But hopefully, this piece will also be relevant to more than just addiction recovery.

Introduction

I’m often dismayed that in today’s society so many of us are inherently materialistic. Individuals, along with organisations that employ us, have a tendency to be so commercially driven that we loose sight of the human factors in what we do.

Organisational ‘mission’ often gets lost in the business administration of commerce… or politics. Even health-care provision and not for profit entities, who are supposedly providing help and support for the vulnerable in our society, can often get lost in the fog of ‘business’ administration and burdens of commercial process.

Economics & Cash in Business

I’m not making any puerile, simplistic or politically motivated and blinkered assumption here. I fully understand economics and the ‘business’ requirements of commerce however; when organisations like the NHS (mostly due to political direction) and ‘not for profits’ become so cash driven, we also need to question our social ethics.

I suppose I can be slightly heartened that my observational comments and questions aren’t part of some lone anarchistic or subversive voice. You see these thoughts are not original, neither can they be claimed as self-developed. They find their solid roots in our history… it’s merely that (perhaps) we have lost sight of what we require.

Back in 1972, the talented chanteuse Liza Minnelli sang wistfully; “money makes the world go round” whilst contemplating a life lived under the rise of Nazism of the Weimar Republic. But even before this melancholic film adaptation of the 1960’s Cabaret stage show, Charles Dickens preceded Liza with his Dombey and Son. A story that in several respects, served to portray both sides of the many arguments around ‘worth’ in the pursuit of wealth.

Today, perhaps more than before, personal and organisational ‘worth’ appears to be something we mostly measure in terms of accrued financial wealth. And too often very little else. Cash is King in today’s world of corporate Motley Fools  (not As You Like It), where business portfolios and investment analysis reigns supreme. With this in mind, perhaps we shouldn’t really be so surprised about the individual drivers of many within our business machinery?

Additional to those financial drivers, most ‘success’ also appears to be predominantly measured and quantified simply from the content of spreadsheets and accounts, relevant to any given six months in time. “How did you do last quarter and can you cut expenditure for ‘efficiency’ (aka profit) in the next quarter?”

Too often there appears to be very little cognisance applied to long-term strategies, all compounded by the fact; too many managers are unable to assess and quantify their own worth, let alone the ‘worth’ [effectiveness] in a workforce with a mission.

These traits and factors are clearly evident (and rewarded) amongst corporate management but sadly, they have also spilled over into our public and third sector service delivery. These factors are also highly prevalent amongst ‘populist’ politicians, the promotion chasing civil servants in ministerial departments and amongst local authority ‘directorate’ leaders. Too many people with power continually chasing enhancement of their public popularity or organisational worth..

The ‘value’ of long-term individual or social change is often by its very nature, something that is notoriously difficult to measure let alone quantify, at least effectively. The inherent human desire for immediate gratification, coupled with short-term rewards process in today’s business tends to dictate; values of long-term outcomes and success are mostly irrelevant… so why even try to measure them?

Business Systems Administration

Its unhelpful when managers and organisations are required to work within systems that ‘punish’ them [financially] for being cost-effective. Where is the incentive for forward-planning when organisations are subjected to budget reductions based on the past frugal management of funds?  Something that has appeared almost annually for addictions services over recent years. Thankfully there has now been some belated but significant and much-needed changes to service commissioning process.

The ACMD heard evidence of examples of funding reductions in local areas in England, brought about through variations to existing contracts and re-procurement of local services. For example, one local authority re-procured its substance misuse services to achieve 32% ‘cost-efficiencies’ over a five-year contract (more).

Past and current budgetary constraints, along with some lack-lustre commissioning factors, have previously had a negative impact on ‘free’ [public] addiction service delivery. Many of these services are actually now provided by third-sector charitable organisations. But many still believing these services are delivered by Government via the NHS. This is no longer the case, at least not across the complete landscape of addictions health-care.

It’s another one of those prominent ‘postcode lotteries’ politically generated in health-care provision. Some of these addiction services services have (arguably and indirectly) collapsed as a result of these political directions (see here),

11 May 2018 – Cuts to publicly funded drug and alcohol treatment have contributed to a 26% rise in drug-related deaths, an addiction service has said. (BBC News)

Misinformed politicians and prominent public misunderstanding, thanks to predominantly stereotypical viewpoints that are fuelled by often mischievous journalism, have ignored much of the science, fact and professional observations in addictions treatment and support. All of which have contributed to this reduction in public service delivery priorities.

Back in 2017, a report from The Advisory Council on the Misuse of Drugs (ACMD) outlined that; “maintaining funding of drug treatment services is essential to preventing drug-related death and drug-driven crime in communities.” However, the money available for both youth and adult problematic substance use services continued to fall. In May 2018, analysis by the BBC found that £162m (18%) had been cut from treatment budgets in England since 2013-14 (see here).

In that 2018 BBC article, UK Addiction Treatment (UKAT), a privately-run commercial organisation said; addicts were being “left on their own” due to continued cuts. I can’t disagree with any ‘cuts have consequences’ thought process however;  the term ‘addicts’ helps to perpetuate stigma and “on their own” suggests that people can’t recover from addiction without ‘treatment’ and support… something that despite common belief, isn’t wholly correct. My cynical head would ask; is there some mission-creep of commercial interest at play here?

It’s also relatively well-known (in addictions support) that around 60% of people, previously impacted by addictions, actually realise ‘recovery’ from their addictive behaviours purely by their own efforts… without any professional treatment or support.

Common (mostly and often) misguided public understanding  around addictions perpetuates the belief – addiction is a disease and it must and can be treated –  much to the glee of some less than scrupulous commercial treatment providers.

In many cases, particularly alcohol dependence, unsupported recovery isn’t something I would advocate, there can be dangers however; it’s also a fact worth remembering, especially if you are considering the ‘value’ (efficacy) of any commercial organisations who might be ‘pitching’ their worth.

Public Health England (PHE) previously said (2018) there was a “7% reduction in people seeking help” from [commissioned] services which “remained free” and offer “minimal waiting times”. The cynic in me would suggest that UKAT were possibly touting for lucrative trade under emotive headlines in the aftermath of a declining framework of public (free) service delivery.  Remember the name and hold these thoughts of commercial interests as I continue.

Chicken or Egg Economies of Scale

A monetary ethos is often one of the ultimate driving forces behind the delivery of many addiction recovery support services, particularly but not exclusively in the USA, where health-care provision is mostly dependent upon individual income and/or personal credit rating.

This wasn’t a prominent factor in the provision of UK health-care, until the dawn of [political] austerity measures. But could the National and international financial crises, arguably caused by our constant pursuit of money, lead to increased commercial interest in UK health-care provision and by some less than ethical individuals or organisations. It’s something that many (including me) worry about.

The spread of the American ‘Opioid Crisis‘, under a landscape of commercial addictions treatment provision,, should worry us all. Across the pond so-called patient-brokering is now an additional but common and unethical phenomenon. As if people addicted to opioids don’t have enough trouble, shady operators have found a ways to exploit them.

Across the country, these “patient brokers” troll streets, drug courts and anywhere they might find people with addiction problems to lure them to treatment centers and “sober living homes…  In a country with 2.1 million people suffering from opioid addiction, business is booming. (USA Today)

So much of what we once expected for free, like UK health-care and social support services, are now charged for, despite the fact that in reality, they were never totally free of cost. Health services are either paid for directly, by the individual (as with the USA) or indirectly, via our taxes paid to the government. Irrespective of any contracting out of those services to third parties by our government and/or local authorities.

It’s also ironic that often (again due to political direction), the cost to the public purse is greater than was previously the case but hey… that’s politics for you! Can’t beat a bit of commercial progress in our age of extended capitalism But all politics and cynicism aside, it must be remembered; most things in life have an associated cost, be it monetary or otherwise.

But our society has conditioned us to believe; services like health-care and social support for the vulnerable in our society, should be delivered free of cost to those individuals, at least at the point of delivery. This type of belief should be a rational (and ethical) assumption for anyone, especially those who believe they reside in a supposedly caring society. Not least the nation that arguably invented (and previously delivered) such a system.

Irrespective of those inherent human traits for pursuit of financial wealth in today’s society, common business practice often dictates pure financial valuation of service provision. In many respects, fiscal factors have overtaken ‘social values’ – perhaps those historic values are no longer relevant or appropriate for our needs?

I accept the public purse is not bottomless however; mismanagement or inappropriate application of factors like Payment by Results (PbR), Value For Money (VFM) and Key Performance Indicators (KPIs) can all present negative impacts for public service delivery. And all that before you even start to consider any of the individual or organisational personal and political agendas that can and do come into play.

In microeconomics, economies of scale are the cost advantages that enterprises obtain due to their scale of operation (typically measured by amount of output produced), with cost per unit of output decreasing with increasing scale.

Many of the economies of scale considerations are behind the demise of some of our smaller ‘community’ based services. Just like the corner shops that are unable to compete, on equal economic footings with giant supermarkets, or the cottage hospitals that have been replaced by regional trauma centres, community based support services find it difficult to serve those in their community. Individual staff desires to continually provide empathetic client focused support, has a tendency to get lost in the mechanics and administration of big business.

It’s sad but true; the overall efficiency of organisational process, particularly but not exclusively within larger entities, can be problematic and sometimes impacted by ‘business’ direction. Overburdening professionals with administrative procedures, target chasing, data gathering for financial and/or politically motivated considerations, especially under the current climate of reduced resources, is hardly conducive to achieving any desired positive outcomes… for the people who are needing support.

There’s (probably) an app for that?

As governments, commissioned treatment services and third-sector supportive organisations all struggle to pay for the much-needed addiction services, thinking outside the box has become a trite business buzzword. Some (who perhaps should know better) believe techno-solutions are the panacea to mitigate against all our financial problems, at least from a ‘cost-effective’ and expenditure perspective.

I can agree that, as with many areas of modern life, technology can assist us in achieving our aims however; those who believe that support process, based purely around technology, rather than ‘cost-prohibitive’ human interventions are short-sighted. This thought process is often misguided, despite there being some undoubted value in this (additional) support provision.

…developing healthy interpersonal connections as a part of recovery and healing is not easy. It takes time, effort, and a willing support network. (Robert Weiss PhD)

As the best-selling author and journalist Johann Hari espoused in a popular Ted Talk (Everything you think you know about addiction is wrong); the human connection aspect of any recovery process is likely to be critical for long-term success. Human ‘connection’ is a known efficacy factor in most recovery journeys. When someone has the strength to ask for that type of help and support; why would we want to replace an effective therapeutic relationship between clients and professionals with technology, other than for financial reasons?

I’m no Luddite or technophobe, quite the contrary however; we would do well to avoid any over reliance on technology, because of budgetary constraints. There is evidence to suggest that technology, where people live the majority of their life in a virtual world, can be a factor behind some people’s poor mental health, which in turn can lead to their addictive behaviours. Additionally, what if/when that technology becomes more expensive, as commercial profiteering comes into play with increased take-up and popularity? What if we see another burst techno-bubble? There are some who suggest the next tech business crash is coming in 2019. Humans don’t tend to fail… when they’re nurtured, fulfilled and provided with the support of other humans (where required). Why remove that humanity factor?

Given the social and political direction over recent years, perhaps we should adjust our thinking and expectations? But, before I get way too political again, I’ll come back to this and try to expand on the underlying issues shortly.

Socioeconomic Factors in the War on Drugs

As I’ve suggested above; political and economic factors, along with that unpalatable but constant human quest for [financial] wealth are often causation factors in many of our social problems, not least of all the fall-out from our politically contrived War On Drugs.

This war, coupled with the myriad social and political policies, has prevented many from holding realistic expectations around inclusion, education, employment or social opportunity. As an unexpected consequence, or even as deliberate act as some argue (see here); we have successfully created a criminal underclass in our society.

A demographic where vast swaths of (predominantly BAME) young people (at least at ‘foot-soldier’ levels), ‘work’ to progress along the seedy, violent corridors of organised crime. They see the illicit drugs trade as their one and only avenue towards personal wealth… something they are often unlikely or unable to achieve by any other means, at least not amongst their own communities.

This ‘war’ resulted mainly from [American] politically motivated economics and imperialistic commercialism. Since the beginning of the 20th century the USA has been ‘fighting’ the drugs trade. You’d expect that failures in the American alcohol prohibition (1920s and 1930s( might have taught them a thing or two but no. True to form, that inherent pursuit of financial wealth in the American Dream came to the fore.

But as with many ‘dreams’ they are often figments of our imagination or, perhaps only realised by a select few, who happen to be a little luckier than their peers. Either that or they come to fruition at the expense of others, especially when personal motives get put before social ones but hey… Never let past failures stand in the way of new commercial opportunities. So, back in the 1970s, America became the world’s self-appointed premiere ‘expert’ on the illicit drugs trade, addictions and the world’s police force for all matters narcotic.

The strategic prohibition policies of America have formed the [failed] War On Drugs. A process that has been shown to be internationally and socially damaging but… the use of mind altering drugs is also big business, from a legal and regulated perspective, as well as in any illicit context. As many entrepreneurial business moguls are now beginning to realise.

But the resulting permanent social underclass of people in many countries means; there is also an exponential growth in people who have few educational or job opportunities. Many of them are punished for their drugs indiscretions, or gain criminal convictions early in their life. All of which leads them destined to a life of limited opportunity (and further crime)… unless they happen to be politicians it would appear (see here).

Putting all the historic international and national political factors aside, there is undoubtedly big money to be made from the underground world of the drugs trade… and the businesses that have grown up and been built on supporting those trying to escape that clandestine world. Yet, according to the European Monitoring Centre for Drugs and Drug Addiction data and research shows; most prosecutions for drug offences remain focused on individuals and their personal use, rather than on those involved in drug dealing (see here).

As the EMCDDA 2019 Drug Report shows;  despite some fluctuations in overall trends, the prevalent beliefs around prohibition and legislation amongst the policy makers is mostly flawed. Last years’ report (2018) showed that more than 92 million adults in Europe had tried/used illicit substance at some point in their life. With those levels, the problems related to the illicit use of controlled substances (drugs) ain’t going away any time soon. More UK specific detailed data can be found HERE.

A pet frustration of mine is the fact; despite the availability of information, provided by Public Health England (PHE) data fed into the EMCDDA guidance, a large proportion of UK drug strategy still finds root in American policy. Either that or evident misinformed socially accepted stereotypical viewpoints and perceptions. All of which serve to fuel continued misunderstanding and stigma. The knock-on effects for addiction treatment and recovery support delivery in the UK is palpable. I often wonder, why are we so happy to continually lay supine and have our belly tickled with American methodology? We have our own ‘experts’ that sadly are often ignored.

I’m not suggesting that all addiction treatment services in the USA are flawed, quiet the contrary however; much of what works there also presents additional barriers for recovery when implemented in the UK… two nations divided by a common language and a big pond etc.

We are different peoples, with differing commercial, ethical, philosophical and social frameworks and foundations, despite the politically contrived ‘special’ relationship. Even Americans aren’t always content with many of their own services. The American commercial rehab industry is a prime example (see here). If it doesn’t work there (allegedly), why do commercial entities constantly strive to replicate the American model in the UK? Again… Cui Bono?

I have no desire to “dis” any of my American friends but this is relevant and needs to be articulated. In the main, the prominent British psyche differs immensely from that of our American cousins. In general, Brits tend to be a little less self-indulgent, they tend to be more secular and inclusive (for now). We are (mostly) more tolerant of diversity, despite (politically motivated) attempts to stir-up hatred. Irrespective of the existential and exponential growth of social media ‘selfie’ trends, most of us tend to be more reserved and less in-your-face than many Americans. We tend not to chase peer or public acceptance of our personality or our behaviours.

How long all this lasts is another question but all that said; why does so much of our UK planning, and response to health and social issues found in problematic substance use, still replicate (often flawed) American methodology? Cui Bono?

The Cost & Efficacy of Addiction Treatment

Don’t get me wrong, I totally understand the concepts of;  “there’s no such thing as a free lunch” or, “you don’t get something for nothing” and “the public purse is finite” – they’re true but also tend to get trotted out with monotonous regularity. I spend much of my working life on the ‘battlefield’ of declining budgets and reduced funding. This politically driven situation serves to make anyone acutely aware of the current situation so yes, I’m painfully aware that almost everything has a price attached to it.

Within The Science Blogs a 2011 article pointed out that one of the oldest adages in existence is that “you can’t get something for nothing” and many websites will tell you that.” But the article went on to question the validity of that statement, with physical rather than philosophical or theological reasoning. That’s all well and good but how often does humanity enter into our frenetic business calculations? Not as often as it probably should, in my opinion.

But even when something appears to be free, there is nearly always a cost to the individual person, an organisation, our environment or, our wider society and the world as a whole… even when that cost is disguised, or not immediately evident.

Hidden costs or impact factors external to the product, service or process being provided usually exist. Physics (according to Newton) says; “for every action there is an equal and opposite reaction.” Now physics may not be applicable to business however; this is always a worthy maxim to hold in the back of your head, through any decision making process.

In 1948, the treatment of addiction was not a pressing issue for the fledgling NHS. Even in the 1970s, it was confined mainly to the treatment of a relatively small number of heroin addicts. But in the years that followed, a combination of social change and increased availability of drugs and alcohol meant that treatment became a key strand of the NHS’s work. The latest report by the National Drug Treatment Monitoring System reveals that in 2016-17 some 279,793 people were in contact with drug and alcohol services in England. Just over half were opiate users. (The Guardian)

I also wholeheartedly believe that for every behaviour, there is a consequence. Broken down into its simplest form; when we make a choice about how to act or what to do, there is a consequence – sometimes good, sometimes not so good. Nowhere is this more evident than within the impacts of addictive behaviours. Being free to make a personal choice, but not being free from the consequences of that choice is a universal paradox.

It’s those metaphysical causality factors or, to put more simply but still in philosophical terms; it’s all about cause and effect theory. Where the cause is partly responsible for the effect, and the effect is partly dependent on the cause… some more of that good old chicken or egg tosh.

We do not have knowledge of a thing until we have grasped its why, that is to say, its cause. (Aristotle)

But substituting my Greek interests for some legalese, answers can often be found by asking; Cui bono  – literally, to who’s benefit? This common Latin term describes the process for identifying crime suspects, it is also a useful tool for unravelling the source in many of today’s business quandaries. Especially those where ethical (and/or political) factors appear to be in play.

A man does what he must – in spite of personal consequences, in spite of obstacles and dangers and pressures – and that is the basis of all human morality. (Winston Churchill)

By the way, according to science, it appears we definitely can get something for nothing; quantum field theory (whatever that might be) not only allows for the ‘free lunch’, it positively demands it… perhaps we should too?

Future Addiction Treatment and Recovery Support?

Moving back on track and away from another one of my slight thought tangents; I am concerned that commercialism is damaging public-health service delivery. Commercial interests, under sometimes questionable ‘charitable’ or not for profit status, are covertly sliding surreptitiously into the foundations and framework of our addictions treatment and recovery services.

I worry that these commercial interests are working to sideline much of the free care that still exists (at least for now), for monetary reasons, despite strong attempts to disguise the fact. This evident business direction is also playing into the hands of those politicians who seek to further privatise (commercialise) the (NHS) health-care sector. At least the controversy, journalistic spin and ensuing arguments around the recent US Presidential visit to the UK served to highlight some of the important underlying factors involved.

Trump visit: Could US companies run NHS services after Brexit? (BBC News)

Irrespective of any validity in the moral, ethical or efficiency drivers that these businesses espouse, or are able to evidence, there has been a significant growth in this area of UK health-care provision in recent years. Adding to my worries, I also have concerns around the prominence for advocating ‘traditional’ American methodology for UK services, not least from these commercial organisations.

Irrespective of how those organisations market and promote ‘worth’ and efficacy, they have a tendency to ignore, or at least try to play down, the valid concerns of many people. I often wonder’ why do people, who have evidently benefited from such systems, also join the camp of vociferous concern and/or condemnation?

Who’s Running Your Rehab and Why?

At the time of writing, funding for treatment and support in private rehab clinics is still available to UK residents. Treatment through a community based rehab, and some private residential rehabs can still be delivered (for now), free at the point of delivery. That said, these resources are limited, often restricted for financial reasoning that results from constrained budgets. Provision can be something of a postcode lottery. Many commercial rehabs and even some addiction services won’t tell you this again for mostly financial reasons.

I don’t have personal first-hand knowledge or lived-experience of these organisations and their facilities, or their often secretive and less than transparent methodology. However; I always find it interesting that so many of my friends, colleagues and acquaintances, who are able to speak subjectively on the topic, also have concerns or can evidence unpleasant or clinically and socially unfavourable experiences.

All said, I’m always open to objective discussions about their methods and efficacy. Secular, science-based conversation free from dogma and personal opinion always supports learning within any personal development process.

A recent blog post from UK Addiction Treatment Centres celebrated 80 Years of the 12 Steps by providing a little history, before moving on to quantify some of the “Facts and Myths about 12 Step Addiction Treatment Today” (see here). I gave the article to one of my ‘expert’ friends for an opinion on its content.

It’s a pretty whitewashed, mainstream version of the founding of AA. Amused to see them dance around ‘abstinence’ …and denounce the god thing without really recognising the true roots of AA. …The structure of the steps and reliving them is deeply rooted in Christianity/the temperance movement. (Anon Expert)

On 12-Step methodology my friend points out (and I agree); Its something where often there was nothing [for those seeking support]. But their ideology around ‘disease’ has caused and still causes; “…harm/damage in communities worldwide due to its dogma and traditions.”

Commodified recovery, repackaged to make it more palatable for the increasingly secular masses. I know a few people that work as 12 steppers in rehabs, and there is a LOT of dogma and terrible practice. (Anon ‘Expert’)

It’s also noteworthy that UKAT (predominantly but not exclusively) have been vehemently denounced by many people amongst the recovery communities for; “spending a fortune on marketing and disguising extortionate prices, poor care and risk elements” in what should be a safe, caring and ‘free’ environment.

Protectionism and ‘damage limitation’ by any of these businesses is to be expected. After all; uncomplimentary discourse around these [12-Step] facilities and their methodology, appears to be in the ascendant.

Why Rehab Fails: The dogma of AA has taken over – The idea of changing the life course for people with severe, recurrent forms of addiction through a time-limited intensive trans-formative rehab is a fatally flawed relic of ancient times. What other chronic disorder do we treat that way? (Sacha Scoblic, New Republic 2013)

I’m not sure these facilities are any better or worse than they once were, merely that people are now asking more rounded and ‘difficult’ questions (often without receiving logical or science-based answers) and consequently, they are formulating new opinions about methods. But importantly, they are also now making more informed choice as to whether they want to engage with these processes… or not, as so often appears to be the case.

And this is what many of these ‘businesses’ (or ‘cults’ in the eyes of some) are concerned and worried about… their reductions to income. But recovery from addiction can be realised without any recourse to historical theological ideals or dogma, irrespective of what you might be told by these facilities.

If the program doesn’t work for you, then you didn’t work the program. If you succeed in staying sober, then you did a good job working the program; ergo, the program works. (Sacha Scoblic)

Scoblic’s article asked the question; “How did this come about?” In many ways, 12-Step ‘treatment’ in the ‘disease’ model perpetuates those past political punitive measures. In many respects it also fails to adequately support harm-reduction initiatives whilst promoting the stereotypes and social stigma connected to addictions.

Since inception back in 1939, there has been almost no science [about AA] that adequately advises and informs people who are desperate to escape their addictive behaviours. In that historic vacuum, the twelve steps of Bill W’s Big Blue Book (and subsequent ‘anonymous’ fellowships) became the treatment template for almost every compulsive behaviour there is… all with sparse empirical peer reviewed research, never mind the dearth of science-based evidence that logically supports the efficacy of ‘treatment’ dictated by the 12-Step program.

Connection and Informed Choice in Recovery

When I talk to people (or write blogs) about addictions, recovery and treatment efficacy, many of those who are reading or listening to my words automatically assume that I’m “totally anti 12-Steps” but that is incorrect.

Nothing could be further from the truth. I’m all about supporting people, irrespective of background or social status, to realise long-term sustained recovery from the impacts of their past addictive behaviours, whatever those issues may be. I also advocate that all people should be supported to make informed choice when selecting any preferred recovery pathway.

I am however extremely uncomfortable with some of the methods employed by (some) commercial entities who deliver support services for addictions rehabilitation. Too many of them appear to be less than transparent with some of their ‘service’ marketing methods. Irrespective of the favourable Care and Quality Commission (CQC) inspections, amongst some of these businesses, which understandably fuel peoples’ perceptions of validity and efficacy.

Thanks to historically ingrained perceptions (mostly of American origin), people (and our society) have been manipulated and misguided towards the incorrect beliefs that imply; you can only ever recover from addiction with the treatment and rehabilitative support provided by dedicated ‘professional’ rehab facilities. Not so, and at least for now, we still have some excellent, effective and free support structures available to support people in the UK who are impacted by addictions.

It might be flippant or even too cynical a supposition however; I can’t help but feel that some of these rehab facilities built their business ethics on American Televangelism and sadly, often some of the less palatable aspects of that particular human support genre (see here). It’s not only crass and unsavoury but no person (or organisation) should be allowed to make money from the vulnerability of other humans… irrespective of the stupidity that can come from vulnerability and desperation. That’s why most countries, who value all humans within their community, usually have safeguarding rules and legislation to protect the vulnerable within that society.

Humans shouldn’t be seen as ‘cash cows’ but unfortunately sometimes they are. I also worry that a ‘perfect storm’ is brewing across the addictions ‘battlefield’, one that could easily perpetuate many more of these past treatment concerns and/or failures, not least the unethical business practices.

I was going to itemise and example some of these business practices however; I have no desire to influence personal opinions, or to castigate any particular organisation for poor business practice, without evidence. I’ve decided to include a brief list of organisations that are representative of the ‘rehab industry’ without any assumptions or influence of opinion. Allowing people to make your own conclusions, based upon sound information is always the most productive way in which to promote informed choice.

Take a look at the following websites and examine their marketing methods, their provision of science-based factual information and their assumed or proven efficacy. Also examine the ‘client feedback’ that they may have received however; please remember that, particularly with the latter, most businesses will only usually publish the most positive and supportive comments they receive. In now particular order;

You will notice that within some of the websites, business trading name choices, website URLs and the ‘about us’ sections of those sites could be seen (by some) as a form of pseudo endorsement by  officialdom.

Sadly amongst some commercial providers, it appears rehab service is dependent upon social class or perceived status. I suspect the potential business profit margins are the main consideration at play here, rather than health-care provision.

There is no hierarchy in addiction and providing support based upon hierarchical demographics amounts to little more than profiteering. Having said that, many people probably wouldn’t seek support from any organisation that caters for the demographics that a client believes to be below their own… the power of stigma in addiction!

But how do I get the support I’m looking for?

To my mind there should be absolutely no hierarchy connected with or applied to any person’s individual suffering. or the support they are subsequently provided with. I’m also all about providing ‘effective’ support with empathy for every individual impacted by addictions, hopefully and ideally free from any new or additional personal financial expense.

I can accept that it’s a reasonable expectation that (wealthy) ‘celebrities’ are asked to pay for their rehab, post any ‘lifestyle’ car crash or breakdown, they have the money to do that. But even that should be done ethically and with empathy. Many of the most vulnerable people in our society, desperately looking for help with their addiction impacts, simply don’t have the available funds to pay for this type of support… neither should they be expected to pay for it!

I suggest that anyone who might be looking for addictions support, should always seek advice from; a) their GP, b) the NHS, c) their nearest commissioned addictions service, or d) one of the third-sector providers, who provide many of those local services, on behalf of your local authority commissioning body. There are also many smaller charitable (FREE) support groups and organisations across the UK. These can usually be found via social media and Google.

If you live in England, and you are set on seeking Rehab support, I would suggest you visit www.rehab-online.org.uk as a starting point and as opposed to one of the above. This site and searchable directory is provided by Public Health England.

Whatever you choose to do… try to be a little cynical or perhaps even a little suspicious but always remember my Latin lessons: Cui Bono? AND Caveat emptor!

Disclaimer: Details about any individuals or organisations named or included here shouldn’t be seen as an endorsement or any allegation of clinical or criminal wrongdoing. They have been referenced either as the author of original and relevant information, or as an example of a given set of circumstances. This post opines my personal observations and experiences and is produced to support individual understanding and learning in others.

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