It’s fascinating to consider what is involved in the development of a recovery community led by a person with lived experience. Of course, no single person is involved alone in developing such a community. However, the initial idea and development often does come from one person.
Here is a story of the development of a recovery community, one that exists within the treatment system, and the National Health Service (NHS) in particular, but connects to a variety of recovery-related initiatives in the wider community. It is the story of the development of LEAP (Lothians and Edinburgh Abstinence Project), as told by its Founder, Dr. David McCartney.
David experienced a sudden and profound change in the quality of his life, and he felt an immense gratitude for ‘having another shot of life’. At one stage, he couldn’t have cared if he had gone to sleep and not woken up. He then suddenly had his enthusiasm and spirit back—things fired him up and he was looking forward to so much.
At the same time, he felt he needed to atone, make amends, for his past behaviour. He also felt concerned that he had not gotten the help that really mattered in facilitating recovery during his ‘first time around’. He felt strongly that people needed to be aware of all the options that were available so they could make an informed choice.
When he went back to being a GP, and saw people with drug and alcohol problems, he was not able to refer them to a residential rehab—the pathways weren’t there for a non-doctor. David felt really uncomfortable about that fact.
He decided he needed to gain a wide range of experience if he was going to try and help people with substance use problems. He completed a Masters degree in Alcohol and Drug Studies, and then spent time working in a residential rehab, followed by a period working in community services primarily involving harm reduction interventions.
David wanted to see a situation where people were offered quality residential rehab as part of an integrated system of care joined up to other forms of treatment. And it should be free at the point of delivery. He started to write down the concept. At the time, he was surprised to find that that services were, in general, not publishing their outcomes.
David pitched the idea of a local community residential rehab to people who commissioned drug and alcohol services. He was asked to write a full proposal for the Scottish Executive, who later funded a number of abstinence (recovery)-based pilots across Scotland. David’s LEAP (Lothians and Edinburgh Abstinence Programme) proposal was funded for an initial period of two years, and a good deal of work went into developing the 16-bed residential rehab and ensuring that a one- and four-year outcome study was undertaken.
At the time, there was both strong support and resistance to the project. In regards to the latter, some people complained that the NHS had no tradition of providing residential rehab treatment. Others complained that the project would put people’s lives in danger, since methadone was ‘saving their lives’.
Resource was quickly outstripped by demand at LEAP. Research showed that outcomes were very good—people were finding recovery and their lives were improving. Residents were being connected to people with lived experience, and to supportive communities of recovery.
David and colleagues also tried to ensure that there were very fluid boundaries between different sorts of treatment, so that if people lapsed or relapsed they could get back into residential rehab or into other forms of community treatment.
David emphasises that when people leave residential rehab they need to be connected to other forms of support and be able to access other forms of treatment. Research has revealed that sustained recovery takes time and some people have a number of treatment episodes on their recovery journey.
David describes being frustrated by the debates about abstinence versus harm reduction. He stresses that both forms of approach are required and different forms of treatment based on these principles need to be connected.
He goes on to talk about the Serenity Cafe and Edinburgh Recovery Activities, where recovering people come together and engage in a variety of recreational activities. He points out that LEAP patients can be referred to other forms of professional support in the community, e.g. for helping people overcome trauma. LEAP has a number of different forms of aftercare group (e.g. women’s group, mindfulness group), as well as a men’s Recovery Housing project.