Why do some health care professionals turn their noses up at the prospect of treating alcoholics or addicts? GPs can opt out of offering evidence-based opiate replacement therapy (ORT) to opiate dependent patients. They don’t opt out of treating hypertension or diabetes. And this is by no means a primary care issue. Generic mental health services are not always welcoming to those with substance dependence.
Some professionals will say they that don’t have the skills to do this, but the skills have been gained by those with the will to learn and do the best for their patients. Take a look at the work of the Royal College of GPs or SMMGP for evidence.
Despite good practice problems persist. Could it be that professional stigma against those suffering from addictions is at the heart of some of this? If so, such attitudes are likely to be poisonous to recovery.
Bill White tackles the subject of professional stigma on his blog. He points out two ‘stark historical realities’:
One, there would have been no reason for a specialized field of addiction treatment if these systems of care effectively addressed the needs of people with severe alcohol and other drug (AOD) problems. Addiction treatment was built on the failure of these allied systems to address such problems.
Two, people with severe AOD problems have been historically excluded, mistreated, and forcibly extruded from mainstream systems of care. The implicit message was: “Riff raff not welcome.”
White argues that the transition from historical ‘moral depravity’ to ‘legitimate patient’ is not an easy one to make. He says that despite those with addictions being a ‘billable commodity’, that this:
has not changed the underlying atmosphere of disrespect and contempt which people with severe AOD problems all too often continue to face.
The root of the problem, argues White, is that while caregivers are constantly exposed to the problematic behaviours associated with addiction, they don’t routinely get to see people in long-term recovery on a regular basis. The result is clear:
Within their professional roles, they know the problem intimately but rarely witness the lived solution.
So what is the answer to the dilemma?
Recovery-focused training of allied professionals is essential to altering these conditions, but people in recovery also have a role to play in this process. Nothing is more effective in altering social/professional stigma than contact strategies, e.g., personal encounters with people in long-term addiction recovery.
Bill White closes his blog by quoting from a speech he made to a Recovery Summit in Minnesota in 2001.
“There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover. The success stories are not visible in their daily professional lives.
We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, and the job supervisors who threatened to fire us.
We need to find a way to express our gratitude at their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been.
We need to find a way to tell all of them that today, we are sane and sober and have taken responsibility for our own lives. We need to tell them to be hopeful, that RECOVERY LIVES!”
Every time someone in recovery goes back to their GP, their CPN or their psychiatrist and tells them what has worked, they will make a difference. Every time a peer supporter volunteers to help other in the treatment system, they will make a difference, not just to the service users they are helping, but to the professionals in the system.
But there’s more. The recent recovery walk in Manchester has been reported as attracting 8000 people. In a week, Scots in recovery and their supporters will walk the Royal Mile in Edinburgh. As Kuladharini (CEO of the Scottish Recovery Consortium) details, community recovery resources are springing up everywhere on an unprecedented scale at phenomenal rates:
In 2012 there were only 11 of these visible, independent recovery support groups in Scotland; in June 2014 we counted 72; led by people in recovery and friends of recovery for people in recovery and the communities they inhabit. In 2012, the chances of them knowing each other were slight. Now the 72 are building into a conscious national network as they lead the planning for this year’s Recovery Walk Scotland.
Such large demonstrations give a positive face and a voice to recovery. They show that recovering people are not ‘riff raff’, but valuable community assets. Over time the visible evidence of recovery in action will provide an antidote to the poison of professional stigma.