The first three chapters of my book Transforming Pain Into Power: The Story of North Wales Recovery Communities provide background to the main story, including some key information relating to recovery-oriented care. Here is a section from Chapter 3:
‘Advocating Recovery-Oriented Care
In my and many others’ opinion, Bill White has been the most influential addiction recovery advocate worldwide. He has authored or co-authored more than 400 articles, monographs, research reports, and book chapters, as well as 20 books relating to addiction, treatment, and recovery. His book Slaying the Dragon: The History of Addiction Treatment and Recovery in America, first published in 1998, is a classic. [1] Bill has long championed the need for the field to shift from a professionally directed, acute-care model, with its focus on isolated treatment, toward a sustained recovery management approach.
The problem with the mainstream treatment system in the US and UK was not just the poor outcomes and the revolving door phenomenon, but also the bureaucratic nature of the business and its resistance to change.
Advocates of the recovery model appreciate that a multitude of factors within a person’s social ecosystem (at personal, family, community, and national levels) influence a person as they travel along their path to recovery. The model differs from the classical medical model, on which much of addiction treatment is based, in that it emphasises empowerment of the person, the importance of peer support, and the involvement of family members in helping the individual find recovery. Rather than focus on pathology and personal weaknesses and deficits, as does the current treatment approach, the recovery model focuses on the person and family using their strengths and assets to travel a path to wellness.
Recovery is not just about symptom management, as is the case of much of treatment today (e.g., most methadone maintenance programmes). It is about the person (re)building a meaningful and valued life, where they can realise their aspirations, be treated with respect and dignity, and contribute to society. In a 2014 paper, Bill White stated the following:
‘As a country, we have invested inordinate attention on person-focused interventions (clinical models) to the exclusion of interventions focused on shaping recovery landscapes (public health and community development models). [Bill was referring to the US, but the same held true for the UK.]
Professionally-directed addiction treatment should not be the first resort for AOD-related problems; it should be the last resort–a safety net to protect individuals, families, and communities. The first line of response should be support imbedded within relationships that are natural, reciprocal (non-hierarchical), non-professionalized, non-commercialized, and potentially enduring. Such relationships are to be found, not within a treatment center, but within the larger community environment. However, significant effort is required to build and sustain such natural resources.
It is time we nested clinical models of care within larger efforts to develop, mobilize, and sustain sources of support for resilience and recovery within the larger community. Grassroots recovery community organizations and new recovery support institutions offer vehicles for long-term recovery support that bridge the clinic and the community. The clinic can bolster the will to recover and the means to recover, but it is the community that must provide the welcoming space in which one can live as a person in long-term recovery. It is time we balanced recovery support within the clinic with recovery support within the community.’ [2]
One of the proudest moments in my career to date is when I gave a talk, The Importance of Community in Facilitating Recovery, alongside Bill White at the conference we organised for him to speak to a room full of UK recovery advocates in March 2009. It was such an inspirational occasion and advocates went away believing that things could really change for the better. Sadly, 16 [now 17] years later, the treatment system and government thinking have little changed. At the time, it was very noticeable that the three civil servants from the NTA we invited to the conference showed a complete indifference to the talks and turned away every time I looked in their direction during my talk.
I finish this section with more of Bill White’s words, which focus on the time when a person first accesses a treatment service.3
‘Most clients entering a treatment environment / relationship do so with fear and ambivalence. The fear is the fear of an alien environment, the feeling of vulnerability and lack of control, and the suspicion that they are in a place where they will not be understood or accepted. The ambivalence embraces both the passionate desire to continue the drug relationship and the whimsical and desperate hope that something magical will occur and transform their lives.’
Bill also emphasises that the earliest moments in the initiation of the treatment relationship must communicate the following to the client:
• ‘You are in the right place;
• You are with others like yourself;
• We understand you and the world you come from;
• We accept who you are and who you can become;
• This is the place where magic (change) can happen.’
Many treatment services fail to communicate this message; recovery communities are far more likely to provide an environment which offers these essentials.’
1. William L. White, Slaying the Dragon: The History of Addiction Treatment and Recovery in America, A Chestnut Health Systems Publication, 1998.
2. William L. White, Addiction Treatment (By Itself) is Not Enough.
3. William L. White, Pathways from the Culture of Addiction to the Culture of Recovery: A Travel Guide for Addiction Professionals, Hazelden, 1996, p. 190.