Recovery Voices: Dr. David McCartney of LEAP

Dr. David McCartney of Lothians and Edinburgh Abstinence Programme (LEAP) talks to David Clark about the development of his drinking problem whilst working as a GP in an inner-city practice in Scotland. He describes an unsuccessful attempt at sobriety, which involved a medical approach focused on prescribing. In crisis, he later called the Sick Doctors Trust Helpline and was told a doctor’s personal recovery story. That telephone call gave him hope and the opportunity to take his own journey to recovery. David talks about setting up LEAP and about facilitating recovery in the community. [15 films, 76 mins 11 secs]

1. Introduction: Dr. David McCartney [1’27”]
David McCartney introduces himself as a person in recovery and as an addictions doctor. He spent the first half of his career in an inner-city GP practice in Glasgow, and the second half working exclusively in the addiction treatment field. He also does work for the Scottish Government supporting the development of residential rehab in Scotland.

Interviewer David Clark (DC) points out that they have known each other since 2007, when he first started visiting LEAP (Lothians and Edinburgh Abstinence Programme), which David Mc had set up earlier. DC had always enjoyed his visits and had continually been inspired by David Mc and his work colleagues and patients.

2. Growing Up Anxious: Dr. David McCartney [4’04”]
David describes how alcohol problems ran through his family for generations. These problems led to uncertainties and unpredictabilities in his childhood which left him feeling anxious and fearful. He developed a hyper-vigilance and would go into survival mode. Rather than ask for help, he internalised everything. Asking for help felt shameful.

When David first tried alcohol aged 17, he found it soothed his anxiety and helped him feel confident socially. However, he did not drink regularly at this stage of his life. He increased his anxiety levels by deciding to go to medical school. None of his family had been to university and the achievements of pupils from his comprehensive school were modest.

3. Medical School [1’40”]
After achieving good grades at school, David found himself pretty average at medical school. He had to work very hard to keep his head above water. Whilst he was from a working class background, most of his classmates were from a privileged background. This all added to David’s anxiety, which he found could be soothed by alcohol.

When he started doing odd shifts in the hospital, David had trouble sleeping. He soon found that having a drink at 4.00pm before going to bed helped him sleep and be better prepared for a midnight shift. 

4. Being Held Back… by a GP Identity [5’12”]
When he finished medical school, David wanted to make a difference and work where the greatest problems were evident. He joined an inner-city GP practice. The job was extremely stressing as the need (medical and social) was so overwhelming.

In retrospect, David felt he was naive and had not learnt to create distinct boundaries. He started to go to work earlier and earlier to be able to deal with all that needed doing in the practice. With the benefit of hindsight, he can now see he was not equipped to deal with all the tragedy he saw.

David felt sympathetic towards people with drug and alcohol problems, but was out of his depth in dealing with these problems. He had received only one relevant lecture in the whole of his medical degree—on alcohol-induced liver disease.

David started to drink more and more to alleviate his increasing anxiety. He eventually realised that his drinking levels were not that different to the people who were coming to see him for their alcohol problems. However, he rationalised that he could not have a problem as he came to work in a suit… and he was a doctor! 

5. Overwhelmed by Shame [7’20”]
As David’s drinking increased, his interests and hobbies started to disappear. Eventually, he was only interested in activities that involved alcohol in some way. More and more the people he interacted with were either drinkers, or people he knew would not criticise his drinking.

His personal honesty eroded as he lied as to why he could not go into work. A mountain of shame grew, and his self-esteem diminished greatly, as he was living against all his personal values. He was a man who desperately needed to ask for, and access, help. Instead, he hid behind the thin veneer of being a doctor.

One major epiphany occurred when David was asked by a woman if he would talk to her brother, one of his patients, about his serious drinking problem. David discovered he was drinking almost the same amount as the man each day.

On the way home, he stopped to buy a bottle of whisky at one of the many places he bought his alcohol. Whilst waiting to pay, he turned around and saw the patient’s sister standing behind him. She wasn’t to know that David would drink most of the bottle that night… but he did. David’s response to his feelings of shame was to drink. However, this event was part of the process which would eventually lead to him asking for help.  

6. Anxiety, Craving and Insomnia [7’27”]
David eventually asked his GP to sign him off work through stress, as he thought he could tackle his problematic drinking when avoiding work. Instead, he started drinking in the mornings, as there was no reason not to!

David confessed his problem to his GP who told him he ‘wasn’t a drinker’—he had been drinking problematically for a decade by now!! He visited a psychiatrist who diagnosed his problematic drinking and referred him to an addictions psychiatrist who in turn arranged a community detox, involving librium and various other drugs. At one stage, David was taking between 20 and 30 pills a day.

This experience was one of the most unpleasant of David’s life. He was extremely anxious and agitated, and couldn’t sleep. He couldn’t stop thinking about alcohol, or focus on anything else. In retrospect, David is glad he had this experience, because he now understands what some of his patients go through when detoxing off alcohol.

David also mentions that his consultant did not think mutual aid ‘would be right’ for him. He is ashamed to say that  he knew very little about mutual aid at the time. 

7. A Miraculous Discovery!? [2’21”]
After a few months, David stopped taking his pills. He thought he could have a social drink, but this turned out to be a disaster. He went back to work, but the craving continued.

One day, David found that if he took codeine his craving for alcohol disappeared. He thought he had made a great discovery. Instead, as he freely confesses, he wasn’t smart enough to connect the dots. He descended very rapidly into an opiate addiction. This time when things collapsed and the consequences were mounting up…

8. Recovery, Connection & Hope [8’23”]
After seeing an advert in the British Medical Journal, David phoned the Sick Doctors Trust Helpline. He talked to a doctor in recovery who told his personal story. ‘His story connected with me in a way the tablets hadn’t.’ David had found hope. He also heard for the first time the idea of recovery as an identity, and as a journey.

The doctor told David he needed to receive treatment in a residential rehab. David found that being in a residential rehab was much harder than he had envisaged. For example, he had to talk about his feelings. However, he wasn’t connected to his feelings and was feeling too shameful to talk. He was disconnected from other people, as well as himself. The only thing that kept him going was this thing called hope.

During a mutual aid group for doctors meeting, he heard his ‘own story’ through the voice of another recovering doctor. This doctor’s story touched David in a profound way and it changed the way he thought about himself and helped him deal with his shame.

Four months after entering the residential rehab, at a time when he was experiencing profound changes, David was told that it was time leave. He replied, ‘Are you sure?’

9. Leaving Treatment [2’25”]
David was off all his medications, but when he went back to his addiction psychiatry consultant, he was told that he should go back on his antidepressants and other medications. David had to say that drugs were ‘not the right fit for me.’ The consultant was doubtful that David could maintain his sobriety, but David told him he had ‘a different set of supports that I didn’t have before.’

David asked his consultant why he hadn’t earlier suggested he attend mutual aid groups. The consultant said that there wasn’t any evidence that mutual aid makes a difference. In fact, there was  evidence at that time—twenty years ago—that mutual aid made a positive difference. David replied to the consultant, ‘I’m your evidence.’

David points out in the film clip that he also didn’t give mutual aid the value it deserves when he was a practitioner, and a lot of practitioners who don’t know about mutual aid don’t give it the value it deserves. 

10. Helping Others [5’03”]
David Clark asks David McCartney whether he found himself helping others, in the way he was being helped by others, when he was in the rehab. David stated that when he found himself functioning more healthily as a human being, and felt that he had some useful things to share, he did start contributing in a way that could help others.

However, he had to first dismantle the veneer of a doctor identity he was using as a mask and shield. This was difficult at first, as a lot of his self-esteem was tied up with this veneer, even though it was holding him back. He had to stop being a doctor and be a member of the rehab community, and then gain the identity of being a recovering person.

David emphasises that both of these elements are important—the self-identity as a recovering person, and the identity of being part of a community of recovering people. David also talks about how he started to write about recovery, initially under a pseudonym as he still lacked confidence, with the hope that he could help other people. 

11. People Need Choice & Opportunity [8’31”]
David experienced a sudden and profound change in the quality of his life, and he felt an immense gratitude for ‘having another shot of life’. At one stage, he couldn’t have cared if he had gone to sleep and not woken up. He then suddenly had his enthusiasm and spirit back—things fired him up and he was looking forward to so much.

At the same time, he felt he needed to atone, make amends, for his past behaviour. He also felt concerned that he had not gotten the help that really mattered in facilitating recovery during his ‘first time around’. He felt strongly that people needed to be aware of all the options that were available so they could make an informed choice.

When he went back to being a GP, and saw people with drug and alcohol problems, David was not able to refer them to a residential rehab—the pathways weren’t there for a non-doctor. David felt really uncomfortable about that fact.

He decided he needed to gain a wide range of experience if he was going to try and help people with substance use problems. He completed a Masters degree in Alcohol and Drug Studies, and then spent time working in a residential rehab, followed by a period working in community services primarily involving harm reduction interventions.

David wanted to see a situation where people were offered quality residential rehab as part of an integrated system of care joined up to other forms of treatment. And it should be free at the point of delivery. He started to write down the concept. At the time, he was surprised to find that that services were, in general, not publishing their outcomes.

12. Setting Up LEAP [4’34”]
David pitched the idea of a local community residential rehab to people who commissioned drug and alcohol services. He was asked to write a full proposal for the Scottish Executive, who later funded a number of abstinence (recovery)-based pilots across Scotland. David’s LEAP (Lothians and Edinburgh Abstinence Programme) proposal was funded for a period of two years, and a good deal of work went into developing the 16-bed residential rehab and ensuring that a one- and four-year outcome study was undertaken.

At the time, there was both strong support and resistance to the project. In regards to the latter, some people complained that the NHS had no tradition of providing residential rehab treatment. Others complained that the project would put people’s lives in danger, since methadone was ‘saving their lives’.

Resource was quickly outstripped by demand at LEAP. Research showed that outcomes were very good—people were finding recovery and their lives were improving. Residents were being connected to people with lived experience, and to supportive communities of recovery.

David and colleagues also tried to ensure that there were very fluid boundaries between different sorts of treatment, so that if people lapsed or relapsed they could get back into residential rehab or into other forms of community treatment.

13. Facilitating Recovery in the Community [4’14”]
David emphasises that when people leave residential rehab they need to be connected to other forms of support and be able to access other forms of treatment. Research has revealed that sustained recovery takes time and some people have a number of treatment episodes on their recovery journey.

David describes being frustrated by the debates about abstinence versus harm reduction. He stresses that both forms of approach are required and different forms of treatment based on these principles need to be connected.

He goes on to talk about the Serenity Cafe and Edinburgh Recovery Activities, where recovering people come together and engage in a variety of recreational activities. He points out that LEAP patients can be referred to other forms of professional support in the community, e.g. for helping people overcome trauma. LEAP has a number of different forms of aftercare group (e.g. women’s group, mindfulness group), as well as a men’s Recovery Housing project. 

14. Going Beyond Stigma [8’34”]
David Clark (DC) asks whether David sees people recovering from drug and alcohol problems as beacons of hope for people trying to overcome other forms of adversity. David agrees that people coming out of addiction have lessons which have utility for people trying to overcome other adversities. He points out that there is research showing that people who survive disasters end up having a better life than if the disaster had never happened to them.

David said that he eventually reached a stage in his recovery when he realised that his life was better now than ever before, even life prior to the alcohol problem. DC says that the good things that recovering people are doing will hopefully over time lead to a reduction in stigma. David Mc says that he has experienced stigma that threatened to stop him returning to his career.

He also describes a situation that occurred when he left rehab and had to go onto benefits to survive financially. He was called for an assessment which included giving a history to a doctor. The doctor took notes as David described what had happened to him, but he made no eye contact with David at all.

Finally, he asked David, ‘What was your job?’ David told him he was a GP. The doctor then looked up into David’s eyes and said, ‘That must have been terrible for you.’ Everything had changed!

David realised that the way the doctor had initially treated him must be how his patients are normally treated. He points out that stigma can be challenged by recovering people speaking out. But there is a risk to ‘sticking your head above the parapet’. However, most of his experience of speaking out has been positive.  

15. Two Final Questions [4’56”]
DC asks David that if he had to use one word to describe the essence of recovery, what would that word be. ‘Hope,’ is his reply. ‘And, of course, you can’t prescribe hope, it doesn’t come in a bottle. There are ways to introduce it and transmit it, but I don’t think we are really that good at doing that in addiction treatment services, generally.’ David believes one of the ways of providing hope is to introduce lived experience.

DC was wondering whether David was going to say hope or connection. The latter says that connection would be a close second. ‘The hope comes from connection.’ The doctor who helped David gave him hope through connection.

DC asks what David’s advice would be to people experiencing drug and alcohol problems. ‘First, ask for help, and don’t limit help to professional help. Make a connection with other people who have been where you are and managed to find a way out…. One of the most profound messages that the recovering community transmits is, “we’re in this together”. Recovery is a journey which is much easier in the company of other recovering people than it is trying to do it alone.’

David concludes by stressing the infectious nature of recovery. ‘When you sitting with a bunch of hopeful people who are absolutely convinced that you can move forward from the dark space you are in, it’s really hard to resist that.’

Biography
David McCartney is an addiction doctor with a background in inner-city GP practice. In 2006, after having recovered from his own addiction, he achieved a Masters degree in Alcohol and Drug Studies and went on to found the Lothians & Edinburgh Abstinence Programme (LEAP)—a residential rehab in Lothian, Scotland, delivered by the NHS and partners. He was part of a group which revised the UK’s ‘Orange Book’ national guidelines and has published several academic papers. For the last decade he has been part of advisory groups on drugs policy to the Scottish Government and currently chairs the Residential Rehabilitation Development Working Group for them.