The grandiose title that came out of a snarky comment on a Facebook post by Alistair Sinclair, chair of the UK Recovery Federation. We’d just seen the recent election results, and while Alistair was being his usual positive and upbeat self – continually reinforcing Gramsci’s wonderful phrase, “Pessimism of the intellect, optimism of the will”, for me, it felt like yet another major defeat.
After five years of defeat. Which really comes on top of a lifetime of political defeats.
A child of the sixties, I often tell people that my own addiction was a response to the failure of the whole new left project of the 1960’s. In 1968, it looked as though a whole new world was not only possible, but was inevitable. The world was filled with new ideas – civil rights, gay rights, a transformation of the old left to something more joyous, more playful. As Emma Goldman said after visiting Russia, “I don’t want to be a part of any revolution where you can’t dance.”
But by the start of the seventies, the creative parts of our culture had been co-opted and was being sold back to us. Labour Home Secretary James Callaghan had completely rejected the Wooton Report, and was implementing the Misuse of Drugs Act – laws aimed at increasing penalties for possession and use. The period that had finally seen an end to post-War austerity, as characterised by Harold Macmillan’s ‘You’ve never had it so good’ was coming to an end, and as I left school, Britain had a million people on the dole for the first time ever. Council rents had just doubled as a result of the Housing Finances Act The politics of neo-liberalism and austerity had begone. In the absence of any positive political project that I could engage with, my own response was a retreat into nihilism and heavy drug use.
For the last forty years, that process has continued unabated. We’ve seen the demolition of the old working class communities – through slum clearance, through mass immigration, through gentrification. And the demolition of the old working class industries – shipbuilding, steel, mining, manufacturing – one thing after another went in search of cheap labour and ended up mostly in Asia.
And we’ve seen the end of the left wing political project. The fall of the Berlin wall brought it home to all of us just how bankrupt the socialist enterprise was when it came to delivering on people’s aspirations. Nobody was migrating into socialist countries. The flow was all towards capitalism – the very thing that ultimately, would come to destroy us? Or at the very least, would tear large rents in our communities and divide us into the rich and the poor, the ‘workshy scrounger’ and the hard working striver.
And there, in the middle of all this, was British drug policy. (Which invariably means British treatment policy.)
The end of the 60s saw the end of the prescribing free-for-all, in which any GP could prescribe heroin and cocaine for their patient for the treatment of addiction. 1968 saw the opening of the first Drug Dependency Clinics, and it wasn’t long before they began to realize that the whole business of prescribing heroin and cocaine wasn’t actually working that well. They began to look to the USA, and in particular, to Dole and Nyswander’s work on Methadone maintenance. That looked promising? Perhaps we should try that?
Nevertheless, throughout the 70’s and much of the 80’s, people were very uncomfortable with methadone. You heard all the same arguments you still hear today – it’s replacing one drug with another. Treatment should be about abstinence. It gets in your bones and turns you green, etc. etc. Patients were regularly underdosed, and all too often the treatment had little impact because of this.
All this was to change though, in the second half of the 1980’s when HIV/AIDS appeared on the scene and it became clear that drug injecting was a major vector for transmission.
Harm Reduction transformed drug treatment – and not just in the UK, but internationally, as well. Today, it’s mainstream drug treatment in most of the world, but there’s been a groundswell of popular opposition to Harm Reduction of late.
Some of this opposition is politically based. If the political agenda from the 80’s onwards favoured disease control and crime control, the political agenda for today is all about austerity and self reliance. As drug consumption patterns change, and the ‘new heroin users’ of the 1980’s have become the ‘old heroin users’ of today, harm reduction has successfully quarantined this group. They were successfully encouraged to remove themselves from a shrinking labour market, and now, twenty, thirty, forty years on, we’re demanding that they re-insert themselves into a market that even the ‘respectable’ working class are struggling to find a meaningful role in.
This discussion was prompted by the outcome of the last general election, when it struck me that, generally speaking, the rhetoric of recovery was very much in line with the rhetoric of the Conservatives. The rhetoric was very much about personal responsibility, standing on your own two feet, voluntarism, rather than relying on the state, and building community to take care of each other, rather than expecting the state to do those things.
Until recently, I was running a volunteer programme for mentors in the drug treatment system, and I was struck by the extent to which most of my volunteers genuinely saw themselves as sick, and felt the state had an obligation to take care of them – not at the jobseekers rate of benefit, but at the much higher rate associated with Disability Living Allowance. It was almost as if Opiate Substitution Therapy had convinced these people that they had some genuinely debilitating psychological illness. Yet if I’d offered any one of them a job that interested them with a reasonable salary, every single one of them would have miraculously found themselves fit for work again. If the rhetoric of recovery was a profoundly Conservative one, then the people I knew in OST were indelibly wedded to the idea of a welfare state that takes care of everyone, from Cradle to Grave, regardless of the contribution they make to our society.
And I’m not criticising these people. In their shoes, I’d probably do the same thing myself.
I had some volunteers who had, in a burst of recovery-based enthusiasm – given up these sickness benefits, only to find themselves desperately trying to re-enrol some time after, because managing on jobseekers was such a struggle. And in practice, large sections of the local ‘recovery community’ continue to live on disability benefits and spend their days watching Jeremy Kyle, browsing the internet on their mobile phones, and going to one of the many daily 12 step meetings that can be found in the area. They might not be using drugs any more, but their friends are primarily addicts of ex-addicts, they still live on benefits, there is little in the way of measurable improvement in their lives that I can detect.
And that’s exactly what you’d expect. The greatest predictor of whether someone will get work in recovery, is whether they’d had work prior to developing a drug problem. And by and large, our drug treatment population is made up of people who have little or no experience of the world of work. High levels of unemployment have characterised most of the large impoverished areas of Liverpool since the late 1970’s. Drugs offered people an economically productive role in a thriving black economy that was otherwise denied to them by mainstream society.
So we’re now telling people, ‘You’ve been on a script for far too long. You’ve got to get out of treatment and into recovery’, well, first we have to be able to offer people a vision of a better life – and one that’s actually accessible to them. For the last ten years, that better life tended to involve the prospect of a career in the drug treatment field – but as the field starts contracting, and levels of accountability and professionalism increase, that’s an area that will be open to ever smaller numbers.
And it was never something that would benefit the bulk of people in treatment anyway. So the key question becomes, where do those people find meaning in a society where work has become scarce? Where do they find community when the old geographically-based communities have been decimated by successive waves of slum clearance and gentrification, rendering feral sink estates one of the few affordable housing choices for the poor?
And to what extent is recovery genuinely even possible without these vital supports of some sort of meaningful activity and a sense of belonging?
And where does the drug treatment system fit into all this? While they’ve demonstrated that they can provide an effective legal opioid rationing system, have they yet demonstrated that they can deliver that thing called ‘recovery’ If so, how do we define it and what does it look like?
For me, the biggest problem with the British treatment system is in this conflation of the legal opioid rationing system with drug treatment. If the only way that somebody could legally get a drink was to enter alcohol treatment, I expect you’d have similar skews there as well.
I believe that we need to separate the two functions. If all somebody wants is a clean, legal supply of opiates, let them have access to that, through a low threshold system.
And there’ll always be a need for people wanting a medically supervised detox, where it’s just too risky or too hard for someone to attempt without support and supervision.
But the real work involved in recovery — those processes of reintegration, reeducation, rehabilitation – those things invariably take place outside and away from treatment, back in the community with family and friends.
So to what extent do these local communities exist? And what do we need to do to facilitate their growth? Is a new community spirit focused around recovery possible? Or can it only work if the notion of recovery is limited to an abstinence-focused idea of recovery?
There are encouraging signs out there though, and much of that hope comes from the USA.
Take the city of Detroit. I don’t think there’s anywhere in the UK that is as socially and economically bankrupt as Detroit was, just a few short years ago. But that city has embarked upon a renaiisance that has grown directly out of the local community, and it’s music and dance/drug subculture.
Similarly, you could point to Faces and Voices of Recovery, or the National Alliance for Medication Assisted Recovery — national advocacy organisations that don’t discriminate against people in opiate substitution therapy, but rather fight against the stigma against this valuable and long proven medication.
Who would have thought that the USA, for so long a regressive backwater when it came to drug policy, would actually end up teaching the UK what a progressive drug treatment should look like?
Over the last few years, the UK Recovery Federation has worked phenomenally hard in an attempt to build exactly this kind of community of recovering people and nobody can take anything away from their success in this respect. But they’ve really just laid the groundwork. The real work must take place in local communities and online, with people who aren’t full time organisers or paid workers, but who are committed to creating the kind of community that’s essential if we’re to stand any sort of chance of surviving.
Ultimately, what the future of treatment, of recovery, of recovering communities — what that looks like — ultimately, that future is up to you.