Dr David McCartney’s Blog

One of my favourite bloggers is Dr David McCartney, Clinical Lead at the Lothians & Edinburgh Abstinence Programme (LEAP). I’ve known David for over 15 years and  I love visiting LEAP when I am in Edinburgh. Here are links to 11 of David’s posts on our website that first appeared on the Recovery Review blog.

Addiction treatment mismatch: when what’s on offer isn’t always what’s wanted
I think people deserve informed choices in treatment where their goals are clearly identified and then we are honest about how the treatments on offer may align to those goals.

A Genesis of Hope
And that’s all about the genesis of hope. It’s about showing them this is what’s possible if you just keep putting one foot in front of the other. And in terms of therapeutic progress, I guess that’s really it in a nutshell: the genesis of hope is to do with connections to other people with lived experience.

Is Medication Assisted Treatment like the Hotel California?
While I absolutely agree that MAT should be offered to everyone who might benefit, our policy makers and commissioners need to be aware of the tension between pursuing logical public health approaches to the exclusion of individual health choices. I have lost count of the number of people I’ve treated over the years who have told me they’ve been on MAT for years and no professional ever discussed rehab with them.

Is Rehab Effective? The Results Are In
For the moment though, we can certainly challenge the voices that say ‘there’s no evidence that rehab works’, for there is ample evidence that it does. I’m not unrealistic about this though. As I’ve been writing, I have been mulling over the wisdom of Ahmed Kathrada’s observation: ‘the hardest thing to open is a closed mind’. That shouldn’t stop us trying.’

“None of them will ever get better”
This nihilistic view of the potential of individuals to resolve their problems and move towards their goals can be explained to some degree by something Michael Gossop called ‘the clinical fallacy’.  This is the situation in which the clinician sees all of the challenging presentations and relapses, while the people who resolve their problems move out of treatment and are not seen again.

Nothing to mourn; just a drug addict
This technique of labelling, blaming, applying stereotypes and stripping those with substance use disorders of their humanity – their sameness to everyone else – might be an temporarily effective way of distancing oneself from the horror and pain of addiction and loss, but it is harmful to those struggling with substances, their families and, if truth be told, to the person using stigmatising language.

Peer recovery support: a bridge to hope and healing
In those circumstances, the introduction of peer interventions and mutual aid is a no brainer – introducing hope, role modelling, practical support and vital connections to resources that will build recovery capital and insulate against returning to harmful substance use.

Rehab works!
This study chimes with what we found in our outcome study from TC treatment in Scotland – high baseline problem severity but significant improvements in a range of measures one year after treatment. There are good reasons to be positive about the impact of rehab and plenty of evidence with which to challenge the naysayers.

Why the empty seats at the free public health lunch?
What else is going on when some of those who work with people with alcohol and other substance use disorders are antagonistic to mutual aid and lived experience organisations? In the last while I’ve heard a very senior medic dismiss lived experience as ‘fake news’ and assert that recovery communities are unlikely to prevent drug deaths. Recovery discrimination and stigma can be just as potent as addiction stigma.

Wiping Out Stigma
While the telling our own stories of addiction and recovery is not without risk, if done well our narratives have the power to humanise, to span chasms, to elicit empathy and connection and to tackle shame. When access to such experiences sits alongside formal treatment, the impact on retention in treatment and treatment outcomes is likely to be significant. As is the impact on stigma.

Women: Drinking and Recovery
When it comes to drinking problems, men and women have differences. Women tend to binge, have higher pre-existing trauma levels and can suffer more (or different) kinds of stigma and discrimination. They are also more vulnerable to physical complications and have greater mental health co-morbidity. Alcohol-related mortality is higher. In my work I’m seeing more young women with alcoholic cirrhosis of the liver than ever before – a worrying trend.