Addiction can’t always be cured so let’s focus on quality of life
Alcohol and substance abuse costs the Australian economy A$24.5bn a year. The human toll from accidents, overdoses, chronic disease, violence, mental illness and family disruption, however, is immeasurable.
Modern, evidence-based policy responses to addiction focus on treatment, where patients aim to withdraw from drugs through therapy and medications. Harm-minimisation strategies such as the supply of clean needles and syringes and the prescribing of substitution medications are also key elements of Australia’s drug strategy.
Associate Professor of Addiction Studies, Turning Point Alcohol & Drug Centre, Monash University points out that while these measures play an important role in how we deal with addiction, little attention is paid to what happens next.
Regardless of how good the treatment is, half to three-quarters of drug users relapse. And the quality of life for problem alcohol and drug users in and out of treatment is low – they’re likely to face social exclusion and discrimination.
This is why so many professionals and policy makers, as well as people with addictions and their family members, are turning to the recovery movement – as many in the mental health sector have done in recent years with great success.
Long journey of recovery
The movement recognises that recovery is a long journey, with addictions typically lasting for an average of 27 years. It aims to address quality of life issues by providing specialist help alongside more practical assistance and referrals for training, employment and relationship-building.
At the heart of the recovery movement is a shift of emphasis away from “treatment” as a model reliant on professionally delivered interventions. Rather, the movement sees the recovery journey an intrinsically social process and seeks to create the conditions that allow those with addiction problems to achieve a sense of connection in their community, including with peers who are further along in the path of recovery.
Whether or not individuals can be “cured”, a sense of meaning and a positive identity is likely to empower people with addictions to improve their well-being, their ability to cope with stress and to manage any ongoing symptoms they have.
The recovery movements in alcohol and drugs mirror similar shifts of perspective and emphasis in mental health and in the rehabilitation and therapeutic jurisprudence movements in criminal offenders.
These approaches argue that the aim of publicly funded interventions should be sustained change located in the family and community (broader public health rather than individual-level interventions), rather than sticking band-aids on symptoms. Therefore, the solutions are relationships, jobs and training courses, not just drugs and talking therapies.
What does the evidence say?
Recovery is strongly linked to social connectedness and to meaningful, social activity. These are the key bridges from alcohol and drug treatment, when it is needed, to effective social reintegration and positive life quality.
From the United States, we know that only around 10% of those who complete alcohol or drug treatment receive community-based ongoing help. Yet, when this is received, it improves the person’s outcomes by 30 to 40%.
Similarly, a 2009 trial of support for problem drinkers found that adding one person in recovery to the social networks of a newly detoxified drinker improved the chances of them staying sober for a year by 27%. This is a huge impact that results from changing not only social networks but the underlying values, attitudes, beliefs and expectations.
A Scottish study of recovering alcoholics and heroin users in the deprived housing estates of Glasgow found that the more time people spent with other people in recovery, the greater the levels of well-being reported.
It also found that people who were active in their families and communities – by parenting, volunteering, being members of social networks, by working and training – had the best quality of life.
A new way of thinking about addiction
The recovery movement is a philosophical shift that recognises that the growth of well-being may happen separately from reductions in symptoms and harms, and that professionals have a critical but partial role in long-term change.
Funding treatment is crucial to saving lives and preventing individual and community harm, but investment in aftercare and linking to recovery communities and meaningful activities is the main way that treatment becomes a portal to well-being.
It is that transformation that will safeguard people with alcohol and other drug problems, their families and their communities from the cycle of relapse and the despair or addiction.