Tim Leighton

1. A Meeting Place & Forum [8’46”]

Tim Leighton and Wulf Livingston first met at a gathering of the New Directions in the Study of Alcohol Group around the turn of the century. Tim was giving an invited talk that was focused on an analysis of 12-Step recovery from the point of view of Cognitive Analytic Therapy (CAT). Wulf points out that Tim was one of the first voices in the New Directions environment who talked about recovery.

Tim found New Directions to be a supportive friendship group. And a safe place to express heretical views about addiction! People were open-minded and respectful of other people’s position, and this pulled them together. He points out that this situation was very different to what had occurred earlier.

The New Directions Group had initially been set up in the 1970s to challenge and offer an alternative to the medically-based disease model which was so dominant in the 1950/60s. In this latter model, abstinence was considered essential for people to overcome their drinking problem. In the 1970s, psychologists started to propose that some of the insights we have from human learned behaviour could be applied to uncontrolled drinking. They argued that some people with an addiction to alcohol could regain control and drink in moderation.

A real enmity grew between people who took one or the other position. People who supported the medical model thought the idea of controlled drinking to be perverse. Conversely, those supporting the psychological model thought the other crew’s ideas to be outdated, paternalistic and authoritarian. Tim hates this sort of conflict of ideas.

2. Enjoying Life in NA [5’41]

Tim fell into drug use in his teens and drugs progressively became more central to his life. However, he led a double life, as even up to the end of his using he was still functioning to some extent—for example, he was attending university. He suspects that his using was about him feeling very lost in the world. He doesn’t think he suffered trauma or anything like that, but he didn’t have a purchase on life. Hedidn’t know what to do with his life. After eight years of injecting heroin, Tim decided he needed to get help. He went off to a clinic.

Tim was now very lucky. In the early 1980s, many clinics that ran the Minnesota Model were very confrontative and dogmatic. If he had gone to one of those, he is sure would have been out the door in a couple of days. His clinic was humanistic and client-entered. They introduced him to Narcotics Anonymous (NA), and again he was really lucky. His group was very tolerant and pluralistic.

That sort of pluralism is not there in all 12-Step groups—they are often very rigid. That works for a lot of people, but not for Tim. Today, Tim is respectful of people who like a rigorous and structured 12-Step approach, but that doesn’t work for everyone. He advises people to try a range of meetings before making up their minds about the 12-Step approach.

Tim had no paid work at this time. He lived in London for two years where NA was his job. He was fully committed to NA and loved it. There was lots to do, as they organised conventions and parties and things like that. He still didn’t know what he wanted to do with his life.

3. A 36-Year Journey [10’14”]

In 1985, Tim was offered a trainee counsellor position at Clouds House, a residential treatment centre in East Knoyle, Wilshire, which began his extraordinary 36-year working experience at Clouds. He became very interested in group therapy; nobody was really trained in this therapy at the time.

Tim was sent to America to see how they trained counsellors over there, which was very valuable learning, but he was always sensitive to the cultural differences between the States and Europe. His experiences there helped him to develop and start teaching a course at Clouds in the late 1980s which eventually became a Foundation Degree course in Addictions Counselling, run in partnership with Bath University.

Around 1990, Tim met Dr Tony Ryle, one of the most remarkable people that he has ever met. Tony invited him to join a group of people who were helping to develop Cognitive Analytic Therapy (CAT). Tim started spending a day a week at St Thomas’s Hospital in London where Tony was offering supervised practice in  the NHS psychotherapy service he was leading there.

Tim likes the fact that CAT is one of the very few psychotherapies that takes the political situation of people seriously. It takes into account the socio-political factors that impact on people’s mental health and wellbeing. Tim emphasises that a lot of other psychotherapy models are highly individualistic and assume a middle-class stability.

He says he was always concerned that there was an inequality of resource for people in the UK for mental health and addiction issues. It’s like what Welsh GP and researcher Julian Tudor-Hart calls the inverse-care law—‘in that medical and other resources are provided in inverse relation to the needs. People who don’t need it get a lot, and people who do need it don’t get very much.’ Tim says that Julian Tudor-Hart’s ideas were also a huge influence on him.

Tim worked for Clouds (which became Action of Addiction in 2007) until 2021, when the latter merged with The Forward Trust. Tim took redundancy at this time and is now self-employed.

4. On Addiction, Recovery, and The Recovery Movement [6’50”]

Tim emphasises that addiction can be very damaging—it damages relationships, self-esteem, and social capital. There is some sort of legacy when you come out of addiction that needs to be mended. A very big hole where addiction used to be. In a way, recovery is about filling that hole. Some people may fill that hole by being part of a community. The culture of recovery is highly social, and this sociality of recovery is what really interests him.

[At the same time, Tim points out that Granfield and Cloud have shown that many people overcome drug addiction without accessing treatment or attending peer support groups].

The sociality of recovery provides meaning and identity. For many people, addiction attenuates their life meaning. Recovery restores meaning. Most people get meaning from relationships, from being able to give and receive, to have fun with other people, and share experiences with others.

One way you can get meaning is to join a group of people who believe in something very strongly, and have rules and norms around that belief system. That way appeals to a lot of people.

However, Tim emphasises that the Recovery Movement can’t be like that. It has to encapsulate people with a wide range of different views, people who are changing their mind about things, people who develop their philosophies, people who identify with some people, but also have solidarity with other people who are not like them. That type of range is very important, otherwise people get left out.

5. Recovery Without Abstinence [6’06”]

Tim is interested in people who recover without abstinence, what that looks like, and whether there is a place for them in the Recovery Movement. Wulf sees these sorts of people in the recovery community in which he is involved, as well as in other spaces. Tim points out that some people return to drinking without having the serious problems they had previously experienced. We don’t really know why some people can do that and others cannot, although we have some insights.

Tim describes his discovery of US recovery advocate Bill White as an ‘Aladdin’s Cave moment’. He started reading Bill’s writings in the early 2000s, and views him as writing so sensitively and wisely ‘about virtually everything’ relating to recovery, treatment and addiction. His writings are not dogmatic and he always leaves a conversation open at the end of an article. He sometimes does not answer the main question, but leaves you with more questions. Bill wrote an article called Can Drug Addicts Drink? which is well worth reading.

Tim points out that it is now more socially acceptable to be abstinent from alcohol and tobacco than it was 50 years ago. That’s very important because it gives people a lot more opportunity. He refers to Nancy Campbell, a hugely interesting commentator on the sociological political and historical aspects of addiction and how people view and respond to it. Her writing is vivid and full of insight.

[The film of Nancy Campbell’s talk Making addiction a brain disease: A social history of addiction neuroscience is well worth watching – DC]

6. On Defining Recovery [5’35”]

Tim emphasises that Phil Valentine’s statement ‘You are in recovery if you say you are’ seems to him profound. The statement has been criticised by many people—can someone who is absolutely pissed out of their head and shooting up smack say ‘I’m in recovery’? That’s surely not what Phil means, thinks Tim.

Recovery is very personal to a person and can take different forms. He believes that people who are on opioid substitution treatment and using it as intended, and are not using anything else problematically and their life is improving, have an absolute right to say they are in recovery, just as much as someone who believes that abstinence is key to their recovery.

Tim emphasises that recognition of people’s needs on the basis of their ethnic, religious and other affiliations must be taken into account when helping people find a safe, secure, congruent environment that facilitates meaningful recovery. People like Sohan Sahota, with his BAC-IN 2Life recovery community in Nottingham, specifically looks at the needs of people in ethnic minorities as they recover from addiction.

Wulf talks about the diversity of activities (e.g. arts-, sports-, green-therapy-based) that people can do in ‘recovery sociality’. This diversity talks to people who have different needs in recovery.

Tim believes that whilst this diversity is extremely important, it can also lead to a sort of vagueness about what recovery organisations are. People with lived experience and recovery are organising such activities in various ways, but because they are so varied it is ‘difficult to kind of define it and then give it some institutional status.’ This could be a good or a bad thing.

7. Treatment & Recovery [9’52”]

Wulf describes treatment as something that people seem happy to prescribe, manualise, and even regulate. It can be something that is similar in one place or another, e.g. a methadone maintenance programme. The individuality and sociality of recovery makes it much harder to prescribe and manualise.

Tim points out that whilst sensible, respectful and structured psychological therapies are often considered as separate technologies (treatments), they produce equivalent outcomes which are modestly superior to no treatment at all. This is known as the dodo-bird effect after the Dodo in Alice in Wonderland who awarded prizes to everyone in a race.

Some psychologists have looked at key factors that occur in all therapies, such as having a good relationship and rapport with the professional with whom one is working. Believing in the efficacy of what you are receiving is also good. However what happens after treatment is key to recovery.

Wulf likes Tim’s idea that treatment is the key to the garden rather than the garden itself. He emphasises that many people have told him that the ‘getting off’ is very much easier than the ‘staying off’. What strikes him is that within the current addiction treatment system there is a greater intensity in the ‘getting off’ part of the journey than in the ‘staying off’ part. Much more funding is invested in the former compared to the latter.

Tim describes an initiative where people in Middlesbrough were sent to a rehab in the south of England a few years ago. Hardly anyone stayed in recovery on their return home, as there was no recovery community to support them. Today, Middlesbrough/Teesside is a centre of excellence for recovery due to their Lived Experience Recovery Organisations (LEROs).

8. Medical, Social and Cultural Factors [9’35”]

Tim points out that there are more recovery resources in the UK today as compared to the past. These are often not professional services, but rather social spaces or friendship and activity groups. In 2006, Bill White pointed out that there was a paradigm shift occurring in the addiction world, from a pathology and intervention paradigm to a recovery management paradigm, where the main role of professionals shifts towards introducing people to recovery and connecting them to recovery resources which can help them create a meaningful life for themselves.

Though this change in occurring in the UK, Wulf says that there are still professionals who say that Lived Experience Recovery Organisations (LEROs) do not know what they are doing. He argues for a better connectivity between the treatment world and LEROs, so people can move from one to another as needed.

Tim points out that many recovery resources help create what is termed ‘social capital’, but many people are going to need both professional medical and psycho-social services and community-based recovery resources. As Bill White points out, one must consider both the severity of a person’s addiction (which often has a physiological basis) and the social capital they possess.

In relation to the latter, addiction is created and sustained by social and cultural factors. Tim emphasises that there have been societies where addiction is practically unknown and other societies, for example the USA, where addiction wreaks particular havoc. Jellinek was one of the first to recognise the role of social and cultural factors in the development of alcohol dependence.

9. Government & Recovery [8’17”]

Wulf asks Tim what he considers enables recovery on the one hand, and hinders it on the other. Tim emphasises that he believes both in grassroots activism, and in an accountable government providing beneficial conditions for a civilised society. He goes on to describe examples of how government policy has hindered recovery over the past 30 years.

The Conservatives developed the first drug strategy, Tackling Drugs to Build a Better Britain, which became an attack on drug-related crime. In the following years, drug problems were treated more as a criminal justice issue, rather than a health issue. People began to be placed on opioid substitution (often methadone) treatment programmes in very large numbers, and often not helped to move on from ‘being parked’ on a powerful sedative drug and the resulting lifestyle that it created.

[TL Note: I am not criticising or blaming people who choose to use opioid substitution treatment in their recovery—it’s the quality of services at this period that I am commenting on.]

David Cameron’s Coalition government were attracted by the ‘recovery’ word and after being told that the 12-Step Fellowships worked (and were free) decided that we’ll use them to get everyone abstinent from drugs. This didn’t work either.

A ridiculously ineffective government alcohol strategy was also developed, one which provided no resources for services, recommended all the approaches without evidence and none of those with, and put most of the responsibility for addressing alcohol-related problems on the drink industry and the individual person.

Tim the describes how the huge promise of Dame Carol Black’s two recent reports are risking being squandered by government. Much funding is already being wasted, or put towards traditional services who have a tendency to provide what is often called ‘spray-on recovery’. He describes some large organisations hoovering up funding by bidding at unrealistically low levels and often then sub-contracting to organisations who can’t help people with the money provided.

10. Reflecting on Stigma [4’59”]

Tim has given up on destigmatisation (he says not altogether seriously), although he hopes other people haven’t done so. If you try to destigmatise, for example by promoting new terminology, there is still a strong persistence of it, and often transference of the stigma to the new terms, as Robin Room has shown. You have to find an enclave where you can hide from it. However, when you are part of a recovery movement and proud of your recovery, it doesn’t mean that the whole of society is proud of you. Addiction is still a misunderstood and stigmatised condition.

When people get into AA and NA they learn a culture of unusual self-disclosure. They become very open and honest. However, it is still not acceptable to be a recovering alcoholic or to have problems with alcohol in much of society (TL note – example: Charles Kennedy, leader of the Lib Dems, vanished from the political scene overnight when his problem with alcohol came to light). Many people today still think of someone who has had an addiction to have something wrong with them and not to be trusted.

Wulf points out that some of the Lived Experience Recovery Organisations (LEROs) are becoming more aware of this situation, and get on with their internal business without massive public disclosure. Many people are extremely judgemental, says Tim. If you are talking to politicians, ‘they are by definition disingenuous.’ They may sing the praise of someone who has overcome addiction, but they are not necessarily thinking that inside.

At the same time, Tim emphasises that you can’t stay silent. Otherwise, you don’t reach people. The main reason why the idea of recovery needs to be widely known about is that people can reach out and grab it.

11. Commissioning & Lived Experience Recovery Organisations (LEROs) [7’07’]

Tim emphasises that well-established, clearly defined LEROs of different scales (from big organisations to small groups) should be funded properly. The money should not go through some ‘contract-hooverer’ big organisation that sub-contract with non-viable levels of funding. LEROs, which are very different to treatment organisations, should receive funding directly from commissioners.

Tim describes a few commissioners around the country (e.g. in Liverpool and Essex) who are very enlightened about recovery and know the services they are commissioning well. Some of these are funding LEROs directly. These people are honourable exceptions and should be models for much better commissioning systems.

Tim thinks a very important part of ‘human capital’ in the field is altruism. People giving stuff away for free. However, you can’t make a living from that. The expectation that LEROs will do everything for nothing needs to be combated. LEROs need to be supported properly.

Tim also makes the interesting point that doing something for free is somewhat stigmatised in today’s neoliberal society. Properly rewarding people and giving them status is very important. However, we don’t want to turn LEROs into commercial organisations. ‘Support them to be the organisations they are, don’t commission them to be the organisations you want,’ says Wulf. Tim believes that commissioners must assess need in the community, and ask, ‘What does this LERO do and how does it add value to the recovery community in that area?’

12. A Social Justice Lens [3’58”]

Wulf asks why are we not just seeing this field through a social justice lens? ‘Because most people aren’t interested in social justice,’ says Tim. He feels that the political situation in the UK and some other countries is quite scary at the moment. ‘There is a rise of a kind of polarised crypto-fascism that needs to be taken very seriously.’

In this situation, a focus on social justice can be hard to maintain. He is not that pessimistic, but ‘that responsibly to build a decent society is I think under considerable threat at the moment.’ He hopes his fears are not realised.