Fighting stigma and discrimination when recovering from problem drug use

Yesterday, I described the difficulty that people recovering from problem drug use face in becoming accepted by mainstream society. They are shunned and socially excluded at a time they need to reintegrate into mainstream society in order to facilitate their recovery and allow them to live a normal life. Here is a related story.

Early in February 2008, I attended with my colleagues Lucie James and Kevin Manley, the first Drink and Drugs News (DDN) / Alliance Service User Conference, which was organised by Claire Brown and Ian Ralph of DDN and held in Birmingham. Around 500 people attended, two-thirds of them service users, a very successful conference. Lucie, Kevin and I enjoyed our day and made some new friends. A special issue of DDN, which was the leading UK magazine focused on drug and alcohol treatment, was devoted to the conference. Prejudice towards service users was obviously an issue that was discussed during the afternoon’s discussion tables.

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Revised ‘Steps to Reintegration’ Model by Julian Buchanan

In an earlier series of blog posts starting here, I highlighted Julian Buchanan’s classic paper Tackling Problem Drug Use: A New Conceptual Framework in which he describes his ‘Steps to Reintegration’ Model, a model which I consider to be both very pertinent and important.

Julian’s paper is based on his twenty years of research and practice with dependent drug users in Liverpool, England. It draws upon three separate qualitative research studies that involved semi-structured interviews with 200 problem drug users. The studies sought to ascertain the views, suggestions and experiences of drug users in respect of what was helping or hindering them from giving up a drug-dominated lifestyle.

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The everyday lives of recovering drug users

I recently found this very interesting and important piece of research from 2012, The everyday lives of recovering drug users by Joanne Neale, Sarah Nettleton and Lucy Pickering, which was part of a Royal Society of Arts project focused on addiction recovery. Here is what the RSA Director of Research, Steve Broome, said about the research:

‘This is a fascinating, in places touching, and, most importantly, useful book. Seldom heard personal accounts from 40 recovering heroin users reveal the psychological, physiological, and emotional journeys as they overcome their addiction. Ultimately, they are human stories that reveal simple and modest aspirations: recovering heroin users want to participate and feel valued as productive members of society. In the words of several interviewees, they just want to feel “normal”.

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‘Out of the dark into the light: The beginning of the recovery journey’ by Rosie

Whilst looking through my collection of ‘voices of recovery’ to see what might be appropriate for the book on recovery I’m writing, I came across this Recovery Stories blog post from September 2013. This is the first of a series of posts that Rosie first wrote on our online Wired In To Recovery community website which ran from 2008-12.

‘Leaving the dark place of my drinking and moving into the light of my new life has been a journey of self discovery—a journey of change—a painful journey at times—a wonderful journey—which has brought me what I was seeking most—peace.

I have come to understand that recovery is a healing process of mind, body and spirit, and time is an essential factor in this process. We cannot expect to recover from the illness of alcoholism or any other addiction overnight. We cannot undo the harm done in a short space of time. This is a fact which I believe is so often not recognised—people are not realising the importance of time in the recovery process.

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‘Tackling Problem Drug Use: A New Conceptual Framework’ by Julian Buchanan, Part 3

Here is the Conclusion to Julian Buchanan’s excellent 2004 paper on the the debilitating nature of marginalisation and social exclusion that many long term problem drug users experience.

‘This paper has argued that the key issues that drug users face are related to discrimination, isolation and powerlessness. Those drug users, who become long-term and dependent, tend to have been disadvantaged and socially excluded from an early age prior to their taking drugs. For many of these people an all-consuming drug centred lifestyle was not the problem, but a solution to a problem.

Social work has a long standing tradition of highlighting injustice, discrimination and inequality, and seeking to empower the service user. Social workers are then, ideally placed to make a significant contribution to draw attention and develop increasing awareness and understanding to the issues of oppression and discrimination that many drug users experience.

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‘Tackling Problem Drug Use: A New Conceptual Framework’ by Julian Buchanan, Part 2

In my last blog post, I introduced a 2004 paper from Julian Buchanan the focuses on helping people overcome problematic drug use. The paper draws upon the messages from drug users in Liverpool, highlighting ‘the debilitating nature of marginalisation and social exclusion that many long term problem drug users have experienced. It concludes by suggesting a new social model to understand and conceptualise the process of recovery from drug dependence, one that incorporates social reintegration, anti-discrimination and traditional social work values.’

In his paper, Julian presents a new conceptual framework for practice that incorporates and promotes an understanding of the social nature and context of long-term drug dependence. Julian’s ‘Steps to Reintegration’ model model is based on the stage-orientated model of Prochaska and DiClemente. He describes six phases, four of which occur before what he terms the Wall of Exclusion and two afterwards.

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Reflections on the Lessons of History: Bill White

Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White isn’t just a fascinating and enjoyable read, it has also taught me so much. Bill White’s book, his other writings, and our meeting in the UK in 2009, have been so inspirational for me.

I’m currently trying to write a book about addiction recovery, which includes details of my own journey (experiences, thoughts and emotions) as I learnt about the field and tried to develop an initiative (Wired In) which I hoped would help individuals, families and communities. Writing the book is quite a challenge and I have done a good deal of reflecting, a fair amount of writing, and lots of correcting!

Today, I pulled Slaying the Dragon off one of my bookshelves to read the last parts. I knew they would help inspire me and provide the fuel for more reflections on the structure of my book. It also made me realise that I needed to post the last sections of Bill’s book in a blog because they are so important for all of us working in this field. I hope they help you in your work and in reflecting on what you do. I can strongly recommend purchasing Bill’s amazing book.

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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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‘I was a heroin addict and had given up on myself. Then suddenly, briefly, I felt a desire to live’ by John Crace

‘What I heard at Narcotics Anonymous changed my life’ … John Crace. Photograph: Pauline Keightley/Bridgeman Images

Yesterday, I posted a blog from one of my favourite journalists, John Crace, the Guardian’s parliamentary sketch writer, about his past heroin addiction. John had been in recovery for 32 years at the time of writing that article. Here is a second article by John about his addiction and recovery, which appeared on 27 December 2021.

At my lowest point, I sought self-annihilation. I was saved at the last moment by two of the few people I had not pushed away.

It was a Saturday night in early October 1986. My 30th birthday party, or what passed for it. Just a handful of junkies and my few remaining friends sitting on the floor of a grey, bare room in a flat in south London. I had thought it would be fun, as, for once, there was no shortage of heroin. Instead, I felt wretched.

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‘How I Overcame my Heroin Addiction – and Started to Live’ by John Crace

John Crace, who became addicted to heroin in his early 20s. Photograph: Theo Moye/apexnewspix.com

One of my favourite newspaper writers is John Crace, the Guardian’s parliamentary sketch writer. He writes really well, challenges the political system and politicians (hitting all the nails on the head), and possesses a wicked sense of humour. Imagine my surprise when I discovered by reading one of John’s articles that he is a recovering heroin addict. Here is that article, straight from the Guardian of 25 March 2019.

Deciding to give up the drugs was easy. But Narcotics Anonymous meetings got me through the really hard bit – staying off them for good

It was one of the easier decisions I have made. So easy that I must have made it hundreds of times over the best part of 10 years. The first time, I was in my early 20s and had woken to find I had cramps, sweats and felt wretchedly sick. That was when I knew what I had fondly imagined was recreational drug use had slipped into full-on heroin addiction. This has got to stop now, I told myself. A couple of days of cold turkey and then get back on with my life – a decision that lasted as long as it took to get up and go to score.

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An Awesome Recovery Story to Start 2022

‘Lockdown imposed the solitude from which I had been running’ … Jamie Klingler with her dog, McNulty. Photograph: Sarah Lee/The Guardian

I couldn’t resist posting this article by Jamie Klingler—I spent years trying to drink and eat myself numb. Then I began a year of intense transformation—which I found in The Guardian today. Here is the article in its entirety.

Who, at my age, truly starts over? But I did. I gave up booze, took up running and found the strength and stamina to fight for a better future.

At 42, I believed that my food and alcohol dependencies defined me. In my mirror, I would always be as I saw myself then: fat and drunk. I was over the hill and past the point of any meaningful change. Who, at my age, truly starts over? I had clearly missed the opportunity to be one of those healthy, mindful people I mocked on Instagram. I was who I was: destined to remain in those cycles of dependency and to be unhappy, discontent and stuck. Then disaster struck.

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‘A Personal Story’ by Wee Willie Winkie

Here’s a story we first ran on our online community Wired In To Recovery in September 2010. I then posted it on Recovery Stories in June 2013.

‘I’m 33 years old. I started taking drugs from ten years old and, apart from a three and a half year stint in the army, took them continuously right up to the age of 30. This included 11 years as a heroin addict.

During this time, I felt totally isolated and alone in the world, and completely worthless. After a few years I was desperate. I’d overdosed a couple of times and, at this point in my life, I’d have welcomed death with open arms. It never came, so I decided to help it along a bit.

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‘A Personal Story’ by Kerrie

This very moving Story was written for our Wired In To Recovery website in August 2011. I published it on Recovery Stories in August 2013.

‘Hi, my name is Kerrie. I am 37 years old. Both my parents died as a result of heroin addiction. My mum when I was 8 years old and she was 28, and my dad when I was 15 and he was 43.

I grew up in the madness of their addiction; needless to say we were a very dysfunctional family. I don’t remember my parents ever getting any real support. The only people involved with our family were the police and social services.

I learnt at a very young age to tell them nothing, as I knew if I told someone, for instance, that my sister and I had been left alone or had not eaten properly for a few days, that my parents would get in trouble. And I was fiercely loyal and very protective of them.

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‘The Astonishing Power of Example’ by Peapod

Here is a post from one of my favourite bloggers on our online recovery community Wired In To Recovery, which dates back to April 2009.

‘Astonishment. That’s what I felt the first time I was taken to a mutual aid group meeting.

I was in treatment at the time in a residential centre. I was also neck deep in trouble. I had lost my job through my using. As part of the fallout from my own million megaton addiction detonation, I’d caused someone else to lose their job. The police were on my tail and I was massively in debt.

I didn’t particularly want to be in treatment, but I’d run out of alternatives. As the detox began to bite (and my god, the teeth were sharp), the permanent fog in my head began to clear. This was not a good thing.

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The Future of Addiction Treatment: Bill White

The following quote is taken from one of my favourite books, Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L White.

‘During the past 150 years, “treatment” in the addictions field has been viewed as something that occurs within an institution – a medical, psychological, and spiritual sanctuary isolated from the community at large.

In the future, this locus will be moved from the institution to the community itself. Treatment will be viewed as something that happens in indigenous networks of recovering people that exist within the broader community.

The shift will be from the emotional and cognitive processes of the client to the client’s relationship in a social environment. With this shift will come an expansion of the role of the clinician to encompass skills in community organization.

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‘My Recovery: A Seminar Opening Speech’ by Adam Brookes

It’s amazing to think that Adam Brookes and I have now been great friends for over ten years, although we’ve been on opposite sides of the world for much of that time. Not any more! Here is a blog concerning Adam that I wrote back in May 2013.

I first met Adam back in 2010 and he quickly became someone very important in my life, a really good friend. He was close to my partner Linda and to my three youngest children who were living with us at the time. I saw that Adam had that something special, that empathic and caring nature that helps people get better. I knew that he was going to help many people.

Adam spent a number of years living in the U.K., but now lives happily in New Zealand. Here is a five-minute speech that he gave to open the Fresh Start Recovery Seminar in Perth in July 2011. Wow, over ten years ago!

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Quitting Use of Cocaine

For a period of four years from 15th November 2004, I wrote a series of Background Briefings for Drink and Drugs News (DDN), the leading UK magazine focused on drug and alcohol treatment. I am slowly uploading these briefings on Recovery Stories as I have time.

Three of these briefings are focused on cocaine—The Drug Experience: Cocaine. In the first part, I explore the dynamic world of heavy cocaine use as revealed in a provocative, high-quality study by Dan Waldorf and colleagues. This research, conducted in the US in the 1980s, challenged many of the prevailing myths about cocaine.

In the second part, I point out that while cocaine is generally portrayed as having a very high addiction potential, the majority of people who use the drug do not have a problem. The research by Dan Waldorf and colleagues reveals a number of social and social psychological factors that influence how a person uses a drug.

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‘We Are Meant to Heal in a Community’ by Douglas Bloch

One of the key messages that I have been putting out over the years that I have worked in the recovery/healing field is  about the importance of community. Here is an excellent article from Douglas Bloch—author, mental health educator and a depression survivor—about the healing power of community which he published in 2013 on the Mad in America website. I first highlighted this blog on Recovery Stories in early 2014.

‘“Anything that promotes a sense of isolation often leads to illness and suffering, while that which promotes a sense of  love and intimacy, connection and community, is healing.” Dean Ornish

In my last blog, I talked about how I was attempting to cope with a “mini-relapse” without using psychiatric drugs. One Sunday morning in the midst of this episode I awoke in a particularly dismal state. I didn’t have a structure planned for the day. And without something to look forward to, both my anxiety and depression increased.

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What Works in Treatment: Sapphire’s Story, Part 3

In my last two posts, we’ve been following Sapphire’s Story with a focus on the treatment she received, recognising that treatment can either facilitate or have a negative impact on the recovery process. We’ve seen Sapphire courageously overcome heroin addiction, crack addiction and most recently an addiction to benzodiazepines (benzos). There’s more to overcome.

‘Once I was off the benzos and feeling a little more like myself, I went back to work. I hadn’t worked since having the crack-induced event, so was really scared that I wouldn’t be able to cope with a job.

As I had come off the benzos, and now had the proper support of a partner and my family, I started thinking about reducing my methadone with a view to abstinence. I knew I had the willpower, as I’d managed eight nightmarish months of the benzo detox and I’d also kicked a crack addiction about two years earlier.

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Learning From the Experts, Part 2

This post continues the research relating to client views on treatment and recovery that Gemma Salter, Sarah Davies and I conducted at BAC O’Connor treatment service back in 2004.

A further factor reported to be influential in producing positive effects was the adoption of a holistic approach, whereby the ‘whole package’ of the person was addressed in treatment, and not simply the substance use problem. The range of targets included behaviours, coping methods, physical and psychological emotional problems, practical problems, social and relationship difficulties, and self-awareness.

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