I liked this review by Alcohol Policy UK of the Ambitions for Recovery Centre for Social Justice think tank policy report that I discussed in this post here. Why? Because it delves into the nuances of the issue in a way that I am only just beginning to understand and so I’m sharing it here.
Treatment and recovery issues
Fundamentally the report calls for the Government to ‘drive abstinence based recovery’ as ‘the most effective way to overcome addiction’ through a number of proposals, including holding local authorities to account to do so. Not exactly localism, and plays to a long-running often polarised debate of ‘abstinence Vs harm reduction’.
Claire Brown, editor of Drink and Drugs News responded in this month’s DDN editorial that ‘such wide-sweeping ownership of the word recovery is not only dismissive of other routes to treating addiction, it’s also a diservice to many of those trying to develop inclusive recovery communities’.
Indeed when it comes to evidence for alcohol treatment, both NICE CG115 and before it, the Review of the effectiveness of treatment for alcohol problems, advocate both use of abstinence based approaches as well as continuing to work with and support those not aiming for abstinence. Crucially it seems, the role of the therapist as someone who works with the service user to help them explore and arrive at their own goals, is imperative to outcomes. Of course so too are many broader factors typically beyond the scope of ‘treatment’.
Abstinence based approaches though are still strongly supported by NICE, including encouraging or at least highlighting the availability of local peer support groups, in reality typically AA or possibly SMART Recovery meetings. However the evidence for residential (inpatient) services – core to the CSJ report – are not as universally supported. Community based provision appears in most cases as effective (and arguably more cost-effective), unless indications of severe physical dependence or other factors are evident (see NICE section 22.214.171.124).
Furthermore, use of language describing others as ‘alcoholics’ or ‘addicts’ as found in the report often carries inherent problems, whereas ‘dependent drinkers’ or ‘substance misusers’ tend to be less labelling and more objectively defined. Without going further, the report’s notions that the treatment field and its commissioners are ‘anti-abstinence’, along with suggestions that abstinence focused approaches for all are far superior, do not appear substantiated.
On reflection, to me their policy guidelines suggest a set of ideas put together by people who don’t actually understand the issues fully whether that be framed in the overall direction of policy in the abstinence vs harm reduction debate or even in the language used to describe those of us requiring the services. And for me it is still hypothetically tinkering around the edges of policy and avoiding the elephants in the room of reduced or banned advertising and marketing of alcohol within the media, minimum unit pricing and reduced access to and availability of alcohol.
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