The same characteristics are likely to define the best clinicians too. In a study, published a few days ago, Pillay, Lubman and our own David Best take a look at what Australian clinicians make of addiction recovery.
They start by looking at the limitations of treatment:
- Lack of consistency between episodes of treatment
- Focussing on a primary problem rather than addressing social, health and legal issues
- Lack of involvement of families
- Lack of referral to mutual aid
What is ‘recovery’?
Definitions exist, but lack of agreement on what recovery actually is can be a problem. The role of abstinence is contentious. As recovery is often seen as a process, say the authors, it is difficult to measure. So what might better capture it?
The study background
The authors explain the context to the study:
Research supports the idea that clinician attitudes can influence client outcomes, where clinicians who are more positive about being able to support client recovery achieve better client recovery outcomes (Simpson et al., 2009). Conversely, ambivalent or negative clinician attitudes are associated with increased client relapse and reentry into treatment (White, 2008).
The aims of this paper are fourfold:
- What do clinicians think ‘recovery’ means?
- What do they think are the risks and benefits of moving to a recovery-oriented approach?
- Do service types and other variables influence attitudes?
- Finally, what are clinicians’ expectations that their clients will eventually achieve recovery?
50 alcohol and other drug clinicians from a variety of backgrounds completed questionnaires. 35 of them also took part in structured interviews.
Definition of recovery
Just over a third said that recovery was ‘moderate controlled use of any drug and alcohol’. A further third said ‘no use of any drug or alcohol’ with the rest in between or not answering.
Risks and benefits of a recovery approach
There was much agreement of the potential benefits, with residential treatment providers being most positive. On the other hand some said ‘that’s what we are doing already’ (always sends up a red flag for me) and expressed concerns that if clients didn’t have recovery goals, then recovery services may seem to exclude them. The balance of harm reduction services and recovery services was also highlighted and the place of 12-step groups ‘imposing recovery’ was mentioned – whatever that means.
Expectation of recovery
Just over half made a stab at estimating the proportion of clients they thought would eventually achieve lasting recovery. The clinicians reckoned about a third of their clients would get there. The world literature suggests it’s about half. In studies professionals consistently underestimate what their clients want and are capable of.
The authors conclude that the term recovery is a contentious one, with many different interpretations and associated attitudes. They suggest that as services embrace change, it will be worth taking time to work with clinicians to create an atmosphere which is conducive to a Recovery Oriented System of Care. To help the process, rather than trying to pin down ‘recovery’ precisely, an ‘overarching set of principles’ will be more useful. Getting recovering people involved in the discussion will be an important catalyst.
This is a small scale study with limitations (which the authors acknowledge) but it still shines a fascinating spotlight on the ambivalence and frustrations some clinicians have around recovery – not least with the term, something we already have research on. People seeking recovery have that ambivalence often too, but can have higher expectations than those treating them. People who identify as being in recovery may have less ambivalence – they know what they value and have worked hard to get it.
We still lack research in the UK on what components of treatment are most strongly associated with enduring recovery and what keeps clients safe on the journey to get there. As we move to deliver on Recovery Oriented Systems of Care in Scotland, we will need to ensure we lose none of the gains and protections of harm reduction while we move towards trying to help more folk move on.
If anything is going to help us it is surely valuing recovery communities and having recovering people at the heart of our treatment and support systems.
Pillay, I., Best, D., & Lubman, D. (2014). Exploring Clinician Attitudes to Addiction Recovery in Victoria, Australia Alcoholism Treatment Quarterly, 32 (4), 375-392 DOI: 10.1080/07347324.2014.949126