‘Lessons from Rehab’: David McCartney

Here’s another excellent blog post by Dr. David McCartney on the Recovery Review blog.

In 2005, concerned at the lack of choice in addiction treatment in Scotland and hearing frustrations from patients and families around lack of access to residential treatment, I sought support and funding to set up a drug and alcohol rehab service based on the therapeutic community (TC) model. This would be unique in Scotland as, based in the NHS, it would be free at the point of delivery, eliminating difficult funding pathways.

I proposed the service should serve a local population to keep people close to their families and allow them to develop local recovery supports and access intensive aftercare. It should develop close working relationships with other treatment and support options – this should be an ‘as-well-as’ service rather than an ‘instead-of’ service. There should be direct family support and detox offered as part of the deal. We would actively connect people to recovery resources in the community, offer them peer support and open avenues into education, training and employability.

Outcomes from rehab in Scotland (and even the UK) at the time were hard to find – but so were any treatment outcomes from services already in operation, so I built in that we should commission a robust evaluation. If this wasn’t going to work, we needed to know that – and if it helped people achieve their goals we wanted to get that message (and any other learning) out there.

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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.

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Is Rehab Effective? The Results Are In: Dr. David McCartney

Here is another great blog post from Dr. David McCartney of Lothians & Edinburgh Abstinence Programme (LEAP) on the Recovery Review blog.

‘Recovery journeys are dynamic, take time and for those who receive treatment, may need several episodes. For some, residential rehab is part of the journey, just as harm reduction interventions can also be part of the journey. However, residential rehabilitation is a complex intervention and complex interventions are difficult to study.

In Scotland, the government is making rehab easier to access and growing the number of beds. This development is not without its critics. Some feel the resource needs to ‘follow the evidence’ – in other words into harm reduction and MAT interventions. This all-the-eggs-in-one-basket position would reinforce the rigid barriers that make rehab the domain of the wealthy or the lucky.

‘Follow the evidence’ in this context is a refrain that implies that there is no evidence that rehab works to help people achieve their goals and improve their quality of life. That is simply not true. Last month saw the publication of a literature review on residential rehab by Scottish Government researchers. It’s a thorough piece of work. This summary of the research evidence provides verification that “that residential rehabilitation is associated with improvements across a variety of outcomes relating to substance use, health and quality of life”.

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A Genesis of Hope: Dr. David McCartney

I hold Dr. David McCartney in my highest regard. He not only overcame his serious alcohol problem, but also set up Lothians and Edinburgh Abstinence Programme (LEAP), a programme that offers structured treatment based in the community using a blend of evidence-based interventions. The patient group in treatment operates as a therapeutic community. I used to love visiting LEAP in my Wired In days, interacting with staff and patients as described in my last blog post.

David is very knowledgeable about addiction and recovery, and posts content to the Recovery Review blog, as part of a community of recovery-oriented experts who write about recovery and related matters. In April 2021, he appeared in a podcast about his addiction and recovery.

‘Switching from doctor to patient was not an easy transition for me. My first attempt at recovery was medically assisted, but only got me so far. What I needed was something more profound: hope, healing and connection to other recovering people. In this podcast for the National Wellbeing Hub, Dr Claire Fyvie interviews me about my own experience of addiction and recovery – warts, wonder and all.’

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Visiting UK Recovery Friends: Part 10 (Dr. David McCartney & LEAP)

After visiting Ian and Irene MacDonald, I headed back to my usual base when I am visiting the UK, the Beech House Hotel in Reading. It’s a wonderful family-run hotel that I have been staying in for over a decade whilst I visit my three youngest children. The next morning, I delivered my hire car back to the main office, and then headed to Heathrow airport to catch a flight to Edinburgh.

I was soon on my way to my favourite UK city where I would be meeting some of my favourite people, the staff and patients at Lothians and Edinburgh Abstinence Programme (LEAP), led by my close friend Dr David McCartney. I first visited LEAP in 2007, at a time when my eldest daughter Annalie was a medical student at the university. For some years, even after I moved to Australia, I would spend the day talking with staff and patients. My discussions with David and his Clinical Lead Eddy Conroy were enjoyable, thought-provoking, and inspiring.

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‘Why the empty seats at the free public health lunch?’ by Dr. David McCartney

When I worked in the addiction field in the UK in the first decade of this millennium, I was surprised how few treatment practitioners encouraged their ‘clients’ to access Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and other mutual aid groups. This fact was all the more puzzling in that the treatment services that were having the most success in helping people overcome substance use problems always strongly encouraged the people  who were seeking help to access mutual aid groups.

Here’s an excellent blog post on Recovery Review from one of my favourite bloggers, Dr David McCartney of Lothians and Edinburgh Abstinence Programme LEAP), about this issue:

‘A few years back in my first few months of working full time in addictions, I attended a seminar on mutual aid. Facilitated by an addiction psychiatrist, the meeting was packed with a variety of addiction treatment professionals.

The facilitator laid out the evidence base for mutual aid as it was at the time and discussed how assertively referring to mutual aid organisations could result in high take-up rates with benefits to patients. This was in the days when most groups were 12-step – SMART and other groups were still to be launched locally.

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‘Peer recovery support: a bridge to hope and healing’ by Dr. David McCartney

I’ve just been reading another excellent post from Dr. David McCartney on the Recovery Review blog.

Good human relationships and social connections are potent protections against both physical and mental ill health. In an analysis [1] involving hundreds of thousands of people researchers looked to see to what extent social relationships influenced the risk of death. They found that those who had stronger relationships were 50% less likely to die early. Loneliness and social isolation have significant negative impacts. You want to live a long and healthy life? Get loads of friends.

In the same way, being connected to pro-recovery social networks improve outcomes in addiction treatment. For a variety of reasons, not least because of stigma, those suffering from substance use disorders are often relatively socially isolated. Guidelines consistently recommend connections to peer groups like mutual aid and LEROs [Lived Experience Recovery Organisations], though this has historically not been a priority for some services. For recovery from alcohol use disorders, being part of mutual aid has an impact at least as great as evidenced psychological therapies like cognitive behavioural therapy. [2]

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Is Medication Assisted Treatment like the Hotel California?: David McCartney

When I worked in the addiction recovery field in the UK running Wired In, I was a strong advocate of harm reduction services, including medication-assisted treatment. However, I spoke out against a treatment system that locked people into a methadone maintenance programme that provided no other therapeutic options, and no opportunity for abstinence-based treatment if people wanted to move on from daily use of methadone. Many people on methadone maintenance programmes were not even made aware of other treatment options.

Here is an excellent recent post on Recovery Review which discusses this highly pertinent issue by one of my favourite bloggers, Dr David McCartney from Edinburgh.

‘The tragedy of Scotland’s drug-related death figures has been in my mind this last week or so. The media may have largely moved on, but those of us who work in the field of addiction, those of us who know individuals who have died and those of us with lived experience of addiction will not be able to do the same.

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‘Addiction treatment mismatch: when what’s on offer isn’t always what’s wanted’ by David McCartney

Another really except blog post on Recovery Review by Dr. David McCartney, this one focused on what people want from addiction treatment.

“I never knew that rehab was available to guys like me”, he said to me just before he completed his rehab programme. He’d been in and out of `treatment for many years before he got to rehab. “Why did nobody tell me?” I was left struggling for an answer.

This is one of the things that still upsets me in my work with patients. It is still happening – even in my area where there are clearly established pathways to rehab with no funding barriers to navigate.

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‘Rehab works!’ by David McCartney

Here’s another excellent post from Scotland’s Dr David McCartney on the Recovery Review blog.

‘When it comes to trying to improve access to residential rehabilitation in Scotland, one thing I’ve heard too often from doubters is: ‘there’s no evidence that rehab works’. Ten years ago I was hearing the same thing about mutual aid, which was recently (at least in terms of Alcoholics Anonymous) found to be as effective, if not more effective, than commonly delivered psychological interventions.

There are a some problems with the ‘there’s no evidence that it works’ line. The first is that even if we accept the faulty premise that there is a poor evidence base, this is often taken as evidence that rehab doesn’t work, which is illogical. The second problem is that while there is evidence, some people don’t know about it or, for a variety of reasons, choose to dismiss it. What we can say is that the evidence base is weighted towards some areas (e.g., medical interventions) at the expense of others. The third issue for me is that while we need to find ways to balance the evidence base, we will not find more evidence if we’re not looking for it.

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‘None of them will ever get better’ by Dr David McCartney

I love Dr David McCartney’s blogs. He writes so well about issues that really matter. He’s also a great guy who cares passionately about addiction recovery and recovering people. And he’s someone I always enjoy visiting when I am in the UK. [Can’t wait until the next visit!] Anyway, here’s David’s latest post on the Recovery Review blog.

Therapeutic nihilism

“None of them will ever get better”, the addiction doctor said to me of her patients, “As soon as you accept that, this job gets easier.”

This caution was given to me in a packed MAT (medication assisted treatment) clinic during my visit to a different city from the one I work in now. This was many years ago and I was attempting to get an understanding of how their services worked. I don’t know exactly what was going on for that doctor, but it wasn’t good. (I surmise burnout, systemic issues, lack of resources and little experience of seeing recovery happen).

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‘Wiping Out Stigma’ by David McCartney

Here’s another excellent post from one of my favourite bloggers, David McCartney from Edinburgh in Scotland. It’s on a topic which is close to my heart—tackling stigma. Here is what David wrote on the Recovery Review blog recently.

‘Reducing the stigma associated with addiction – the word itself now tagged with a degree of stigma – is a priority in drugs policy. Stigmatising attitudes contribute to drug harms and deaths through delaying access to treatment, leaving treatment early and increased risk-taking behaviour.

Brea Perry and her colleagues at Indiana University took a look [1] at the scale of the problem of stigma for non-medical prescription opioid use and dependence in a representative sample of over a thousand adults in the USA.

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‘Women: Drinking and Recovery’ by Dr David McCartney

My good friend Michael Scott, of Michael’s Recovery Story, and I attended a Public Awareness Meeting of Alcoholics Anonymous (AA) in a Perth suburb today. I was asked to talk for five minutes about my recovery work over the years. I also described some of the factors that facilitate recovery.

We listened to a number of AA members share their stories and I have to say that I was blown away by the high quality of the shares. They were moving, inspirational and insightful. More women than men spoke. It was such a good meeting and I really enjoyed talking to people after the actual meeting ended.

Imagine my surprise when I got home to find that my good friend Dr David McCartney had just uploaded a blog post about women, drinking and recovery.

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‘Nothing to mourn; just a drug addict’ by Dr David McCartney

When I developed Wired In and worked in the addiction recovery field, I was living in South Wales. When my daughter Annalie was in medical school in Edinburgh, I used to fly up from Cardiff to visit her. I soon came to love Edinburgh. That positive feeling for the city increased greatly when I met Dr David McCartney.

David ran Lothians and Edinburgh Abstinence Programme (LEAP), a programme that offered structured treatment based in the community using a blend of evidence-based interventions. The patient group in treatment operated as a therapeutic community. David was in recovery himself. I loved visiting LEAP every time I was in Edinburgh, and meeting the patients and staff. I’d sit in on group sessions and spend time talking to the patients. David and I became good friends and I hold him in the highest regard.

I’ve recently been checking out David’s blog on Recovery Review. He writes so well and covers a number of key themes relating to addiction recovery. Here is David’s latest post, ‘Nothing to mourn; just a drug addict’, focused on the issue of stigma.

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