That are a number of hierarchies that are continuously reinforced in the alcohol and other drug world, be it policy, practice or research. Most of them stem from a conservative defence of vested interests and perceived intellectual and moral high ground. Some of them are just bloody rude. Often the net result of this is what I think of a set of centric (geographical, medical, professional and political) worlds with little regard beyond a token dropping of loose change at the peasants.
I would like to offer a brief story which is so typical of the many I and others experience daily. This is a very short version of the long tale. Sometime a few months back, someone in Cardiff (probably civil service) tried to organise a two and half hour session for the UK head of the Addiction Mission to come to Wales [Cardiff of course] and find out everything she needed to know about what was going on in Wales.
I was asked with just a weeks’ notice if I could then do the nine hours round trip to attend the said meeting. I declined to undervalue those commitments already made to others in my diary and joined online. A room full of predominantly medical folk, maybe 12 people, all from South Wales and me the only one from the rest of the whole of the country. We were told we had ten minutes each to outline our bits of the story etc. Well after the lackadaisical chairing allowed two (my memory says) psychiatrists to overrun for 45 minutes (or such) and with time running out for all, someone finally noticed my online presence and invited me to contribute just before I had to leave to attend another meeting. By the way, there was no Lived Experience in the room, and I was the only one to mention recovery. [My bold – DC]
It felt highly excluding. It was London, medical problem, and deficit-based eccentric exploration, with a tokenism towards Wales and then Cardiff tokenism towards the north, and a non-existent tokenism towards the Lived Experience Voice. I can only imagine the same story happens in numerous other parts of the alcohol and drug world. There was a promise of course to contact me and arrange for a further chat, chance to input etc. I am still waiting.
Back to the crumbs. My problem with this is that it all feels like an inverse investment of time and resources, of that which matters most and might make the most long-term difference being that which is regarded, the last, the least, as an after-thought and if there is any spare change left in the commissioning pot. The pecking order goes something like the top dogs are those in the medical and statutory health frames (they get the giant slice of the pie). The police and prisons are not too far behind. There might then be a serving or two for those doing some cognitive work, outreach, harm reduction, housing, etc, often in the third sector. And then there is the peer-led, independent recovery and social community groups. They are permitted to survive on the crumbs.
Yet if we really talk to those who have lived the life, are living the life, they will tell you the order of importance and therefore possibly investment should be the other way round. The important bit, the stuff that really matters is the long-term sustained maintenance of a different alternative life. It is what occurs after treatment. To paraphrase: the getting off (however essential) is the easy bit, the first stage, the window of sobriety; the staying off, giving back, feeling self-worth, filling the voids, and building a life is what really matters.
Why do we continue to invest 90% of the resources, time, effort and allow 90% of the agenda to be dominated by much of which might at best be considered the starting point, 10% of the window? It is probably easy enough to say this small alcohol and drug world just mirrors the larger one, that which is perpetuating economic, health and social injustice. The rich getting richer and the powerful getting more powerful. The sharing of resources, the acknowledging of the other, the humility in humanitarian notions of reciprocal sharing cast aside as invalidated, loony ideas of those who do not know what is good for themselves. Don’t believe me—just turn on the TV, read the newspaper etc, and watch it all being played out in 2024, the year of elections all over the globe.
Plus ça change, plus c’est la même chose. (The more things change, the more they stay the same.)
‘The Addiction Mission, announced as part of the UK’s Drug Strategy: From Harm to Hope, and delivered as one of the Office for Life Sciences Healthcare Missions, is aiming to help reduce this cost by enhancing the UK-wide research environment and incentivising the development of innovative and effective new treatments, technologies and approaches to support recovery, and reduce the harm and deaths addiction can cause.
In November 2022, £30.5 million of government funding was announced for delivery of the Addiction Mission. [What on earth does a Vaccine Taskforce have to do with an Addiction Mission? cf. the link]