In recent months an increasingly polarised debate has developed in the UK which has tended to portray abstinence and maintenance approaches to drug treatment as an ‘either/or’ issue. At its most extreme, the debate appears to suggest that substitute prescribing is incompatible with recovery.
We felt that this debate was becoming increasingly divisive, with little reference to the evidence on treatment effectiveness which indicates a treatment system should be composed of a range of different services to meet different needs. It appeared to be diverting attention away from more legitimate questions, such as whether individuals in need of drug treatment have enough choice, particularly with respect to residential rehabilitation, the variability in quality of sevices of all types and if there has been too much focus on numbers in treatment and retention rates rather than outcomes, i.e. progress toward recovery.There was also concern that the debate risked undermining the wider public message that drug treatment (generally) is a good thing that should be supported and properly funded.
Part of the issue behind the debate appears to be a lack of clarity and agreement about what treatment is trying to achieve and what we mean by the term “recovery”. Without greater clarity about the goals of treatment and rehabilitation and the dimensions of benefit, it is obviously hard to commission or deliver the individually tailored packages of care that are required to meet the very varied needs of individuals with different presenting and underlying problems. As an independent, charitably-funded body established with the aim of stimulating informed evidence-based debate about drug policy, UKDPC wished to make a positive contribution. Inspired by the work on recovery being undertaken in the mental health and addictions fields in the UK and internationally, the Commission decided it would be helpful to identify the common-ground and develop a clearer understanding of recovery that could be applied to all individuals tackling problems with substance misuse, and all services helping them, without reference to particular treatment modalities. The need to consider and include the full range of experiences of recovery was considered essential. As US expert on recovery William White has commented: “How recovery is defined has consequences, and denying medically and socially stabilized methadone patients the status of recovery is a particularly stigmatizing consequence”