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Keane, Martin (2011) UK expert group reports on recovery-oriented treatment. Drugnet Ireland, Issue 39, Autumn 2011, pp. 17-18.

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The UK National Treatment Agency (NTA) has published an interim report by Professor John Strang,1 chair of an expert group set up in 2010 ‘to provide guidance to the drug treatment field on the proper use of medications to aid recovery and on how the care for those in need of effective and evidence-based drug treatments is more fully orientated to optimise recovery’ (p. 2).The author makes ‘some early observations’ under three key headings: consensus reached on a number of issues, how services can improve the quality of treatment offered in the short term, and a vision of what recovery-orientated services can become. These observations are summarised below.  

Consensus on a number of issues
The group acknowledged the strong body of evidence that supports the effectiveness of opiod substitution treatment (OST) and seeks to build on this evidence to develop a recovery platform which will achieve even greater outcomes. It recognised the expansion in treatment services in the UK and the benefits to patients through a concerted drive to reduce waiting lists and improve retention in treatment. It also acknowledged, that, in some instances, there has been an over reliance by clinicians on prescribing medication, and ‘patients being allowed to drift into long-term maintenance’ (p.3).The group shared the view that ‘the prescribing of any medication (and perhaps especially of OST) must not be allowed to become detached and delivered in isolation from other crucial components of effective treatment. Other elements of overall care need also to be considered, including individual recovery care planning, psychosocial interventions and integration with mutual help-groups and peer- support’ (p.3).
 
Key elements of effective drug treatment
A comprehensive individual needs assessment that is undertaken early and is ongoing throughout treatment is a key part of the treatment process. The group is agreed that ‘assessment should not be a process that happens to someone but one in which they are actively involved’ (p.4). 
 
A recovery plan tailored to the patient’s needs must be developed collaboratively between the clinician and the patient and should be reviewed regularly and revised when appropriate. This report repeatedly stresses the importance of regular reviews of the recovery plan: ‘if an individual is deriving little or no benefit from an intervention, then it should be modified and tailored in partnership with the patient so that the provision of treatment delivers identified and valued benefit’ (p.4).
 
The group recognised that the eventual package of recovery-orientated treatment services was likely to appear complex to service providers, and that services will need time to adjust and will require training to reorient themselves towards a balance between harm reduction (reduction of negatives) and recovery (accrual of positives). The report lists some immediate steps services can take to begin to strike this balance. These are summarised below.
 
1.     Undertake an audit of your service to assess the current balance between overcoming dependence (recovery) and reducing harm to ensure that both objectives co-exist.
2.     Review all your patients to ensure they have achieved abstinence from their main problem drug(s) or are actively working to achieve abstinence.
3.     Consider changing the current balance between recovery and harm reduction to encourage more patients to pursue recovery.
4.     Let your patients see other patients who have successfully exited from treatment by linking your service to a recovery community, or employing ex-service users or using them as volunteers or as recovery mentors and coaches.
5.     Ensure adequate support is in place for patients who wish to reduce and/or stop using their medication and that rapid response mechanisms are in place in the event of relapse.
6.     Audit the availability of key psycho-social interventions using as a benchmark the interventions recommended by the National Institute of Clinical Excellence (NICE)2 and the audit tool recommended by the NTA and the British Psychological Society.3
7.     Strengthen and develop the social networks around patients including families and access to mutual-help groups.
8.     Establish opportunities for patients to accrue social capital via employment placements, vocational training and volunteering.
9.     Ensure all key workers are trained and supervised to deliver psychosocial interventions to a competent standard. Effective key working should also involve building collaborative interventions to develop the insight of patients and help them build a more integrated lifestyle by attending to their employment and housing needs.
 
A vision of what recovery-orientated services can become
The report outlines an eight-point vision for the future in which services will:
 
·         continue to recognise the role of prescribing medication, but not as an end in itself, rather as one component part in an integrated treatment package that minimises risk and promotes each patient’s recovery;
·         develop and support staff to adopt and promote recovery among patients and train staff to deliver evidence-base psycho-social interventions alongside prescribed medication;
·         make visible to all patients entering treatment the range of treatment and recovery options available and the likely trajectories through options and possible destinations;
·         maximise what individual can achieve with a clear emphasis on movement and progress for patients;
·         recognise the achievement of preventing further deterioration in the most severely damaged patients;
·         involve the families and carers of patients in their recovery planning;
·         develop close links with the community to promote reintegration of all patients; and
·         work with clearly defined guidelines that will allocate clearly defined roles for medication in stabilising, maintaining, detoxing and preventing relapse among patients.
 
The report identifies four key issues which require further intensive consideration: (i) distinguishing between the proportion of patients who might be expected to recover rapidly with no or modest substitute prescribing and the proportion which may need long-term care, including substitute prescribing (this issue is being addressed by a sub-group of the main group), (ii) how can treatment help patients to build ‘recovery capital’, the social, physical, human and cultural resources seen as necessary to initiate and sustain recovery from addiction? (iii) how can recovery capital and its accumulation be measured? and (iv) how can treatment services decide who receives what intervention, when they receive it and how is it best delivered? The last three issues will continue to be addressed by the main body of the expert group.
 
Recovery capital is mentioned as a key conceptual driver of their vision of recovery and further work on assessing how treatment services can help patients to develop recovery capital is underway through a sub-committee of the group. Drawing on the work of the French Sociologist Pierre Bourdieu and the concept of social capital, Cloud and Granfield (2008) 4 conceptualise recovery capital as the sum of resources necessary to initiate and sustain recovery from substance addiction. Recovery capital includes the social, physical, human and cultural resources needed to advance the recovery of drug users. Such resources include networks of non-drug using friends and supports (social capital), tangible assets such as secure accommodation and regular income through employment (physical capital), social and personal skills, education, mental and physical health and career goals and ambitions (human capital) and values, beliefs and attitudes that promotes social reintegration and the ability to live within socially prescribed norms (cultural capital). The full report on the work of the group is expected to be available towards the end of 2011 and will be covered in a later issue of Drugnet Ireland.
 
1. Strang J (2011) Recovery-oriented drug treatment: an interim report. London: National Treatment Agency for Substance Misuse. www.drugsandalcohol.ie/15524
2. NICE (2007) Drug misuse: psychosocial interventions. Nice clinical guidelines 51. London: National Institute for Health and Clinical Excellence. www.nice.org.uk/CG51
3. Pilling S, Hesketh K and Mitcheson L (2010) Psychosocial interventions in drug misuse: a framework and toolkit for implementing NICE-recommended treatment interventions. London: National Treatment Agency for Substance Misuse and British Psychological Society. www.drugsandalcohol.ie/13622
4. Cloud W and Granfield R (2008) Conceptualising recovery capital: expansion of a theoretical construct. Substance Use and Misuse, 43(12–13): 1971–1986.
Item Type
Article
Publication Type
International, Open Access, Article
Drug Type
All substances
Intervention Type
Rehabilitation/Recovery
Issue Title
Issue 39, Autumn 2011
Date
2011
Page Range
pp. 17-18
Publisher
Health Research Board
Volume
Issue 39, Autumn 2011
EndNote
View
Accession Number
HRB (Available)
Subjects
A Substance use and dependence > Personal history of substance use (pathway) > Recovery
HJ Treatment or recovery method > Substance disorder treatment method
VA Geographic area > Europe > United Kingdom
J Health care, prevention, harm reduction and treatment > Patient / client care management
J Health care, prevention, harm reduction and treatment > Risk and needs assessment > Needs assessment
J Health care, prevention, harm reduction and treatment > Treatment and maintenance > Treatment factors
J Health care, prevention, harm reduction and treatment > Treatment and maintenance > Provider / worker / staff attitude toward treatment

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