Walking the recovery talk

On Friday I went to a debate hosted by Mike Weatherley, MP for Hove and Portslade. It followed hot on the heels of a drug policy roundtable convened by Caroline Lucas MP, in whose Brighton Pavilion constituency I live.

Friday’s topline theme was drug-related deaths. Brighton is the so-called ‘drug death capital’ of the UK, having the highest per capita drug mortality rate in the country and roughly one drug-related death a week, according to 2009 figures (although the trend is down). The event was structured into four themed sessions, bringing forth evidence, strategy, opinions and personal stories from a range of speakers, examining drug-related deaths from the perspectives of social exclusion, medical treatment and criminal justice.

Let me give you some feedback that will help me make my points, which are beyond the specific issue of drug-related deaths. We heard some statistics that offered up obvious responses. Most deaths occur in users’ homes, or in friends’ homes, and most are ‘witnessed’ – there are people (other users, for example) present, who are willing to act in an emergency but who often don’t have the requisite knowledge or equipment to intervene while they wait for the ambulance. Brighton leads the way in training peers and professionals in how to use naloxone, an opioid antagonist and ‘antidote’ to a heroin or morphine overdose. Further roll-out in training and availability of naloxone to the family and social networks of users is progressing, but nationally more could be done through service user groups, needle exchanges and so on.

We learnt that a high proportion of people who suffer drug-related deaths in Brighton migrate here: they do not have easy access to the social roots and support connections afforded by a local upbringing, education and family. Our own work on problem drug users in neighbouring West Sussex shows that they are often trapped in social networks in which the only people they are connected to and draw support and influence from are other drug users. This makes recovery more difficult.

And we heard that while Brighton has the worst drug related death figures, its rate of drug use generally is only in the top third nationally. Why this conversion rate? It seems there are clusters of problematic users and associated behavioural norms that are fed by a wider cultural image of Brighton as a place where, in the words of one speaker, you do things “on the edge”. On a related point, we heard that among young people, there is a perceived normalisation of drug and alcohol use.

When the sessions opened up for debate, there were some opposing views (to decriminalise or not, to focus solely on abstinence based approaches or not), but it was clear that all those in the room were in some way connected to drug policy, commissioning or services. We were all energised and motivated to change things, but in essentially talking to ‘ourselves’, there were two themes notably missing from the conversation and participants.

Firstly, there did not seem to be representation from the (local) private sector (outside of a local private health provider).  Brighton has a rich creative and night-time economy and some of the comments from the floor suggested that there was a positive feedback loop in which Brighton’s image as a ‘party town’ and its provision for partying are mutually reinforcing. Our Connected Communities programme has been looking at ways in which businesses can move beyond what is often tokenistic Corporate Social Responsibility towards the idea of Shared Value, in which social and economic objectives align and in which the social problems that are currently perceived as externalities are brought into the core business model, creating value for both business and local people. This requires a significant shift and we have explored how businesses and local people can co-produce objectives and action for mutual gain. While Brighton’s economy and citizens gain a lot from its creative industries, this line of thinking might be brought to bear on Brighton’s drug and alcohol issues. (More on this line of work in later RSA Projects posts.)

The second issue is how to make connections to citizens and institutions beyond those already engaged and concerned with substance misuse. The saying (variously attributed) goes that in theory there is no difference between theory and practice, but in practice there is. In theory, the national drug strategy sets out a vision of recovery, with strong social and economic ambition for what drug users can be supported to achieve. In theory, we are driving practice towards what works through mechanisms like Payment by Results – functioning PbR should be more expansive, more ethical, and more empowering because of what is shown to work. And in welfare reform more broadly, we are demanding a ‘fairer’ exchange between citizen and state – with the right of support comes the responsibility of social and economic contribution. These elements should be mutually reinforcing.

But what about the practice? How we commission for recovery is key. We must ensure that re-integrative support, during and particularly after structured treatment, is available. Too often people return to the social networks in which problems developed and that are least able to provide the support, influence and opportunity necessary to sustain recovery. There is a danger that our vision of recovery may be undermined by commissioning that is too focused on cost, while the lack of public finance elsewhere erodes social support in the third sector and wider job opportunities.

Saul Alinksy suggests that in order to create change, we must start from how the world is and from people’s lived experience, and create a bridge to a possible future world.  This bridge, in part, needs to be commissioned and co-produced with users and communities. According to our research (and others’) the overwhelming majority of substance misusers want to be drug free, in work or education, with nourishing relationships with family and friends. But as our Whole Person Recovery report illustrates, “a lack of confidence, stigmatisation, chequered employment history, health issues, criminal records, and addiction” mean the jump to this future world is often overwhelming.

To aid recovery journeys, we must both strengthen and extend networks.  Without doing this we risk further excluding marginalised people in the re-drawing of rights and responsibilities. Localism, as Caroline Lucas has said, provides Brighton with an opportunity to develop a contextualised approach that taps into its culture and rich social capital and that creates City-wide networks of support for people recovering from substance misuse.

In reference to the earlier statistics, this might include, on the one hand building capability within drug users’ networks to administer naloxone. And on the other, it should include tapping into the social and economic capital of local people and businesses and extending it to those without access to it. This will not be achieved, however, until we think of and treat people exiting structured treatment as assets in communities, rather than problems to be contained or controlled in marginalised settings.

Next year’s national Recovery Walk will be in Brighton and can perhaps help forge connections and spread this message at scale. As one of Friday’s speakers suggested, treatment is but the soup of the three course recovery dinner. The proof of the practice of recovery will, if you like, be in the pudding.