One of the clear recommendations to come out of the recent hard-hitting Expert Review on delivering Opioid Replacement Therapies in Scotland was to do with research. It seems there’s not much addiction research going on in Scotland. How well are our treatment services doing? We can’t really say. Anyone reading the review could reasonably conclude, sadly, that addiction research has officially been proclaimed missing in Scotland. Glimpses are reported from time to time, but overall, nobody’s been holding out much hope.
It’s not as bad as I’m painting it, for I know of many small scale projects going on across Scotland. I also know how hard researchers have to work to find funding and how many negative responses there are for funding bids. I’m not sure the problem is lack of interest.
The Chief Scientist’s Office for Scotland is a major research funder. The Expert Review gives us an outline of the problem:
The most recent report shows that, since the publication of the Road to Recoveryin 2008, the CSO has received reports of only 5 research studies they funded, relating to substance misuse outcomes. During this same period, the CSO received reports of 216 studies on other topics. According to their own report, only 2.7% of CSO funding, under all headings, was in the area of substance misuse.
The report called for a robust approach to research in Scotland, but also for us to think more widely than purely medical research, something that has resulted in a gross imbalance in the evidence base to the arguable advantage of certain groups, but not necessarily to the benefit of clients seeking recovery.
Such research programmes should not simply address medical treatment. Evidence-based medicine has its own pitfalls.
They must also encompass social research, developmental research and “translational research” – acknowledging the basic science which underpins addictive behaviours and may hold the key to the understanding of its development, associated risks and effective approaches to prevent or treat the condition.
The translational elements of research or technology transfer (turning findings and recommendations into practice to benefit health) are challenging. Dozens of papers that are relevant to addiction and recovery are published every month. Only a few people read them and many are simply passed over. Doing things better ought not to be beyond us, as others have managed better:
Historically, in other countries (USA, Australia, England), facing the challenge of increasing, complex substance use problems, national processes were set up to efficiently develop the infrastructure required to support programmes of the long term, high quality research that is required to address the unresolved questions we face in Scotland today.
Recovery research – R.I.P.?
If addiction research in Scotland really is missing, then recovery research appears to be dead and buried. The Scottish Government-commissioned ‘Research for Recovery’ review of the literature found that the evidence base was not as good as it might be; the majority of the work was on alcohol, not drugs; much of it was from the USA; and a lot was now dated.
The authors laid out some questions:
- What is the role of treatment and other forms of community intervention and engagement?
- What are the catalysts and mediators of change?
And three priorities for future research:
- Recovery-specific research
- Treatment and interventions
- Prevention and public policy
Social revolution missed?
Those recommendations were made four years ago. In the meantime we are seeing some remarkable changes in recovery community landscapes across Scotland with peer-led initiatives springing up and mutual aid groups growing in number. In Lothian we have three recovery café settings with a further one planned for East Lothian. There are peer supporters in treatment services, people with lived experience employed and the visibility of recovery has never been greater.
All of this is happening at a remarkable pace. The landscape is changing rapidly. Compare this with where we were five years ago. It is astonishing. It’s arguably more astonishing that we don’t have people queuing up excitedly, desperate to record what’s happening.
Where are the social scientists scoping and measuring this? Who is researching this mini-social revolution in Scotland? Where are the funders? How many academics are trying to find the missing ‘body’ that is recovery research? Where is the leadership? I wonder if peer-led research might be able to plug the gap to some extent. The Scottish Drugs Forum has a track record in this area.
There is good news. A group has been commissioned by the Scottish Government to address this. Hopefully recovery research is not six feet under, but just waiting to be discovered. Not dead, but sleeping and about to burst into joyful life. Am I right I wonder?
[This is the first in a series of three blogs focusing on addiction and recovery research. The others will follow soon.]