Describes the author’s story, and his development of the grassroots initiative Wired In; the eBook Our Recovery Stories; the nature of substance use problems; changing behaviour and recovery, and the nature of addiction treatment. (4,024 words)
‘The energy and experience of people affected by substance use problems is at the core of what we do. We harness this to give them a voice, enabling them to help themselves and others, and influence practice and policy and the views of society.’ Wired In Charter
1. David’s Story
I spent the first 25 years of my career working as a neuroscientist, studying the role of the brain neurotransmitter dopamine in normal behaviour and in disorders such as schizophrenia, Parkinson’s disease and addiction. In the 1990s, my team’s research became increasingly focused on brain mechanisms underlying addiction.
At the time, neuroscientists and major funders, such as the National Institute on Drug Abuse (NIDA) in the US, promoted the idea that addiction was a medical disorder and that neuroscience research would lead to new pharmacological treatments for addiction.
However, by the end of the millennium, I realised that I had become a frustrated neuroscientist! Whilst our research was going well, and I could tell a good story about brain mechanisms underlying drug addiction, I did not feel that I (nor any other neuroscientist) was actually helping anyone overcome their addiction. I did not believe that addiction could be ‘cured’ by a drug.
I was intrigued by addiction and wanted to know how people overcame the problem. One obvious way to understand the nature of addiction, and recovery from addiction, was to talk with people who had overcome a serious substance use problem.
I met some addiction treatment agency workers in Swansea (Wales), some of whom were in recovery from addiction, and they introduced me to some of the people they were helping. I was soon inspired by a small group of recovering people, not just by their bravery in overcoming their personal problems, but also by their strong desire to help other people.
I decided to close down my neuroscience laboratory in the Department of Psychology, University of Swansea, and develop WIRED (later to become Wired In), a community-based initiative focused on helping people overcome substance use problems.
I continued to learn about addiction recovery and addiction treatment by visiting services around the UK, meeting with service users and people in recovery, and reading key literature. It soon became evident to me that addiction is not a medical disorder that can be fixed by a medication or any other treatment, or by a doctor or treatment practitioner.
Recovery comes from the person with the problem. They do the work in overcoming their substance use and related problems, getting well, and getting their life (back) on track. Recovery is a process of self-healing. Practitioners may facilitate recovery, but they do so by catalysing and supporting natural processes of recovery in the individual.
I also learnt that recovery is something that rarely occurs in isolation. People with a serious substance use problem need to connect to other people to facilitate their recovery journey. The connection to recovering people, and their stories of recovery, play a key empowering role by providing hope, understanding and a sense of belonging.
Recovering people and their stories provide hope by showing that recovery is possible via a multitude of different pathways. They help other people understand the nature of their problem and how it can be overcome. People in early recovery trust, are inspired by, and learn from people further along in their recovery journey. Recovering people support each other, allowing people to gain a sense of belonging, and feelings of acceptance and self-worth that are key to recovery.
Over the following years, Wired In developed a range of activities focused on empowering and connecting people suffering from serious substance use and related problems, in order to facilitate recovery. We delivered information, education and personal stories (written and film) via our high-profile, internet-based information infrastructure, which included the world’s best-known drug and alcohol news portal (Daily Dose) and other websites.
We conducted a wide range of research activities, which included projects focused on client views of treatment, as well as evaluations of a variety of treatment and related services. I wrote a bi-weekly education column for the country’s leading magazine in the field, Drink and Drugs News.
We engaged people in recovery as Wired In volunteers, in order to help develop a ‘voice’ of recovery, collaborated with recovery-oriented advocates in the field, and started to connect high-quality initiatives around the country.
Our aim was to facilitate the development of a recovery advocacy movement in the UK. In this regard, we were highly influenced by the work and writings of the leading US recovery advocate William L White. In collaboration with Action on Addition, we later arranged for Bill to give a talk in London to leading recovery advocates from around the country, as well as government officials.
People started to think that Wired In was a well-funded research institute. The truth was that my team comprised a few talented psychology ex-students, current students, and volunteers (generally people in recovery). We existed on minimal funding, despite the numerous funding applications and requests for funding that I made.
The aim of Wired In was not just focused directly on people with substance use problems, but also their loved ones who had their own needs and wants. We also wanted to help improve the addiction treatment system in the UK, as well as impact on the beliefs and behaviours of members of the general public. People experiencing, and trying to overcome, substance use problems often face prejudice and discrimination in their everyday lives. Prejudice and discrimination are major barriers to recovery.
The mainstream addiction treatment stream was focused on delivering the UK government-based drug strategy. This strategy classed drug addiction as a criminal justice issue and focused on prescribing heroin addicts the opiate substitute methadone as a maintenance treatment.
It was ironic that having left a medical-related field behind me, I was now interacting with a system that was using a medical model. A system focused on: pathology and weaknesses, rather than assets and strengths; managing symptoms, rather than helping clients gain a valued and meaningful lives; the role of a practitioner and drug, rather than linking clients to peer and other forms of support, and helping them gain additional internal and external resources (recovery capital).
There was a poverty of ambition for clients and many practitioners had little belief that clients would move beyond their methadone prescription. ‘Once a junkie, always a junkie,’ is something I heard some practitioners say. The addiction treatment climate in many places lacked hope, opportunity and choice. It was disempowering.
The problem was not methadone per se, but with the way the treatment system was delivered. Methadone is an important tool in helping some heroin addicts reduce harm to themselves from street heroin, and help them on their journey to recovery. My colleagues and I saw good examples of the use of methadone in facilitating recovery.
As a result of problems in the treatment system, far too few people were finding recovery from addiction. Clients circulated in and out of treatment, the so-called revolving door phenomenon. The system became overloaded with paperwork, focused on measuring outcomes (number of people being prescribed methadone), and in justifying itself. More and more practitioners became disillusioned.
My team and I wrote articles about treatment and our project evaluations, and highlighted good practice. We helped clients and recovering people speak out about poor, and good, treatment practices. When highlighted in the context of a story, these criticisms or commendations were all the more impactful. Wired In team continued to highlight the advantages of the recovery model over the medical model.
I worked closely with Simon Shepherd, who was the Chief Executive of the Federation of Drug and Alcohol Professionals (FDAP), the professional body for the drugs and alcohol field that worked to improve practitioner standards. Simon asked me to become Chair of the Professional Certification Advisory panel for FDAP, another way in which he and I thought that Wired In would be able to influence treatment practice.
In 2006, I took early retirement from my university in order to focus on Wired In and develop an online recovery community, Wired In To Recovery (WITR), which I had been dreaming about, and trying to get funding for, since 2002. We started to build this community, and collect and prepare a wide range of content, six months before our official launch at the end of November 2008.
Our aim was not to just to work through this online community, but also embed ourselves in communities around the country and use WITR to connect recovery communities, recovery-based initiatives, and anything else that would help people recover from addiction.
WITR community members had access to a number of recovery tools: various forms of content, including articles on key topics or issues, Personal Stories, blogs, film clips, discussion forum, and links to resources. The community provided an environment in which people could inspire and learn from each other and provide mutually beneficial support. We established a ‘people’s journalism’, or Voice of Recovery, which acted as a strong source of advocacy both for recovery and the Recovery Movement.
After four years, WITR had attracted over 4,000 members, who were from around the world and had a diverse range of backgrounds. A significant number (over 1,000) of community members blogged, generating over 7,500 blogs and 35,000 comments! We received a considerable amount of positive feedback about the quality of our content, the supportive nature of the environment, and how well recovery and recovery initiatives were being promoted. Many individuals emphasised how much they are being helped therapeutically by being a member of the community.
At the end of 2008, I moved to Perth, Australia, due to personal circumstances. I continued to run WITR and returned periodically and met up with leading recovery advocates around the UK. Sadly, due to circumstances described in My Personal Story at the end of this book, WITR was closed down at the end of 2011. I was devastated by the loss of the recovery community.
2. Addiction Recovery Stories: The book
In 2013, I launched the Recovery Stories website, an educational initiative focused on helping individuals and families recover from addiction and mental health problems. After a number of subsequent years developing an initiative focused on the healing of intergenerational trauma, and researching and writing a book about the fascinating story of a group of Aboriginal child artists in Western Australia, I found myself being drawn back to the world of addiction recovery.
It has been over 20 years since I closed my neuroscience laboratory and started working on Wired In projects in the community. And eight years since Wired In To Recovery closed down. During those 12 years, I learnt so much, met so many amazing people, and had so many positive experiences (and some bad ones). I have missed the field and the friends I have made on my journey.
Earlier this year, I realised that it was time to try and make a contribution to the field again. I approached the authors of the original stories on the Recovery Stories website, and asked whether I could publish their original story, along with a seven-year update, in an eBook.
All but one person wrote back to me and agreed that their original story could be published. Twelve of the authors agreed to do a story update. Some wrote their own story, others were interviewed over Skype on a number of occasions (or in one case, in person) and I wrote story drafts for discussion and redrafting.
Some of these storytellers are close personal friends who I first met on my Wired In journey. Others I have never met in person, but have corresponded with since they first posted a blog on WITR. Some have used their real names, others wish to remain anonymous. I am very grateful to each and every one of those storytellers. I am thrilled by the quality of the stories. I know they will have an impact.
I know that people who read this book will have a wide range of experience of, and knowledge about, the addiction recovery field. For those people who are relatively new to this field, and are ready to plunge themselves into the world of recovering addicts and alcoholics, I have provided a brief primer to some of the key concepts and themes in the world of addiction, addiction recovery and addiction treatment.
At the end of all the Recovery Stories, I have written a chapter entitled Factors That Facilitate Recovery, that includes quotes from the various stories.
For those of you interested, I have provided a more detailed version of my Story (Brain Chemicals to Human Connection), which includes acknowledgment of the roles and work of the people I have met on my journey, at the end of this book.
3. The nature of substance use problems
The vast majority of people who try illicit drugs or drink alcohol do not go on to experience problems. However, a significant minority do experience problems that eventually impact negatively on their physical and mental health and their social circumstances.
This harm can arise from the direct negative effects of drugs (e.g. long-term alcohol causes liver damage), indirect effects arising from repeated withdrawal symptoms (e.g. depression from long-term cocaine use), and the negative effects arising from the lifestyle associated with illegal street drugs (e.g. contaminants in street heroin, hepatitis C from sharing needles).
Long-term drug or alcohol use can lead to addiction or dependence. In simple terms, addiction can be seen as an impairment of a person’s ability or power to choose. The substance becomes more important than other aspects of their life, which the majority of people would consider as essential. Addiction drives forward heavy and persistent substance use, ultimately increasing the incidence of harm.
‘In one word, trapped. I knew I had the ball and chain from that day onwards…. I could see no light at the end of the tunnel whatsoever. It [heroin] had got me. I was being sucked down every day further and further.’
Self-control is impaired and the user or drinker persists in using the substance even when they know the dangers and their rational self tells them to stop. An individual’s drug and alcohol problems also often impact on their family. Communities are also affected as a result of anti-social behaviour, family breakdown and increased levels of crime.
Addiction is a complex condition involving biological, psychological and sociological components that represents a major challenge to treatment practitioners. Unfortunately, there are no magic bullets or simple interventions that are all embracing in the treatment of addiction.
4. Changing behaviour and recovery
Many factors moderate the development of an addiction to substances, and help create exits from initial engagement and problematic use. In general, people are less likely to become addicted to substances if they have few life problems, and good personal and social resources, such as healthy self-esteem, strong family relationships, and non-drug using friends. In addition, if a person can find satisfaction and happiness in other activities, they are less likely to become addicted.
In general, people are more likely to become addicted to substances if they have complicated personal problems (e.g. depression), few personal resources (e.g. low self-esteem), and live in a deprived social environment offering few alternative pleasurable activities. Serious substance use problems often occur as part of a larger cluster of psychological, physical, family and social problems.
A variety of factors can change problematic substance use once it has developed. For some people, the problems are transitional in nature and they mature out of them as their setting changes, e.g. other life events become more significant, such as setting up a home with a loved one. Other people spend years misusing substances and suffering negative consequences and losses, before dying without overcoming their problems.
For many people, their substance misuse involves multiple attempts either to stop using or to bring their use under better control. The majority eventually resolve their substance use problems, often on their own without formal treatment.
In general, it is easier to resolve substance use problems at earlier and less severe stages of problem development. For some people, reduced use or abstinence can be triggered by relatively brief interventions, the impact of which is thought to be on the person’s motivation for, and commitment to, change.
A common obstacle to early help-seeking is ambivalence and the perception that one does not have a ‘problem’ serious enough to warrant change or treatment. Once this ambivalence is resolved and a commitment made, change may proceed without much additional support.
For other people, their problematic substance use is part of a larger cluster of life problems that can become very resistant to change. Family factors and social networks may be central in establishing and maintaining the substance use problem. It is important to understand what maintains substance use in these individuals and, more importantly, establish which components need to be addressed to produce stable change.
Recovery is a word used to describe the process through which individuals with serious substance use problems resolve these problems and establish a meaningful and fulfilled life. Recovery involves the development and use of coping strategies and techniques that reduce a person’s vulnerability to relapsing back into problematic use.
Recovery, or overcoming problematic substance use, is rarely an isolated event. A person may make a number of attempts to stop using a substance before they finally stop permanently. Each of the attempts at stopping involves events and processes that the person can learn from and that can ultimately contribute to recovery.
There are many different ways that people overcome addiction, and no two people take identical pathways to recovery.
However, there are four main types of help that facilitate recovery. These include the person using:
- their own strengths and resources
- the help of family members and other loved ones
- support groups in the community (e.g. Alcoholics Anonymous)
- formal treatment.
People may utilise these different types of help at different times in their path to recovery. Some may find one type of help more beneficial than others, although this may change over time. For example, treatment may play a large role at the beginning of the recovery process, whereas later on help may be sought from loved ones and friends during difficult periods.
Whilst there are many routes to recovery, they all have two things in common. Firstly, they all come from within the person. Self-change is the foundation and the process underlying all recovery.
Formal treatment is a time-limited, circumscribed experience or series of experiences that interacts with and hopefully enhances the self-change process on the way to recovery. Treatment can facilitate the initiation of recovery, but is not in a person’s life long enough to produce long-term recovery. The initial ‘gains’ facilitated by treatment in the early stages of recovery are built upon by the person’s interactions in their social environment and facilitated by recovery-related resources in the community.
Secondly, all routes to recovery involve behavioural change. A change from a problematic behaviour to one that is healthier for the person concerned. In general, people pass through a sequence of stages on the way to resolving substance use problems. In brief, they:
- become concerned about the need to change;
- become convinced that the benefits of change outweigh the costs, and make the decision to change;
- create and commit to a feasible and effective plan of action;
- carry out the plan by taking the actions needed to make the change;
- and, consolidate the change into a lifestyle that can sustain the change.
A person may move forward and backwards between the stages on many occasions, before they finally achieve a sustained recovery.
A variety of processes, occurring within the person and in their environment, combine to help them move through the stages of change. Achieving and maintaining change depends on using the right processes at the right time. This can help explain why it can often take a person numerous attempts to overcome their substance use problem.
5. Nature of addiction treatment
Drug and alcohol treatment services exist primarily to help and support those people who develop problems from their use of drugs and/or alcohol. A range of services and agencies has evolved that aim to reduce the harm that individuals cause to themselves.
Treatment may involve clients abstaining from drugs or alcohol completely, or may involve a form of harm minimisation, such as encouraging clients to use clean needles to inject in order to minimise the risk of infections, such as HIV or hepatitis.
People present for treatment, advice and support at various stages of their substance-using career. Therefore, treatment agencies need to be able to respond to a variety of different situations that may involve different interventions.
Some people who use drugs recreationally may only require information and advice from a treatment agency. Others can be helped by a brief intervention. For example, a brief intervention may involve the assessment of alcohol intake and alcohol-related problems, followed by information about how to cut down on drinking.
Some people present for treatment with severe substance use problems. A significant proportion of these people present with a variety of other intimately related problems. They may be homeless, jobless and experiencing problems with personal relationships, have a history of criminal activity, and have a physical and/or mental health problem.
People with severe substance use problems often require an extensive package of treatment and aftercare, sometimes involving medical, psychological and social interventions. The importance of aftercare should not be under-estimated. It is much easier to stop, than to stay stopped.
It is widely accepted that the best approach to treating a person with a serious substance use problem is to treat the individual as a whole (holistically), rather than simply focusing on trying to reduce his or her intake of substances. Thus, in trying to help people overcome their substance use problem, treatment services may need to help clients access other forms of support, such as housing services, social services, mental health services, education and vocational training.
Practitioners must also be aware that relapse is a common attribute of addiction. Some people remain abstinent for many months or years before initiating substance use again, whilst others continue to periodically pop in and out of treatment agencies over long periods of time.
Other people who visit a treatment agency permanently abstain from drugs and alcohol and go on to lead full and healthy lives. In fact, their recovery may represent a better life than they had prior to developing their substance use problem.
Many people seek out treatment services because they want to stop using substances, but believe they cannot do it themselves. They look to other people to help them overcome their substance use problem. Some of these people find they cannot just stop using—they may have tried on many occasions—so it is essential they receive support that helps them minimise the harm that drugs and the drug-using lifestyle cause them.
They may decide after an initial visit to a treatment agency to use needle exchange facilities, and at a later stage they may feel ready to engage in a methadone programme. Sometime later, they may decide that they want to be abstinent from all substances, but this process may involve various stages.
Some people access treatment because they are seeking relief from the discomfort or pressures of a drug-using lifestyle. The day-to-day existence of someone with a serious substance use problem can be tough and the person may look to others for help in dealing with the problems in their life.
Treatment agency workers can support users through periods of crisis, e.g. helping them deal with homelessness, problems receiving benefits, or health problems. Often their role will involve facilitating access to others who can provide more direct help.
In these circumstances, agency workers can take the opportunity to engage users in other services, educate the user about harm minimisation, and try to enhance motivation for behavioural change. This support can be critical in the early stages of a person’s recovery journey.
> Prologue
