My conversation with David Best reflects some of our shared reflections over the last 15 years of involvement in recovery in the UK, and beyond. David is a leading contributor to much of our knowledge about what is recovery, how it works, how it can be measured, and the nature of recovery organisations.
What comes from this conversation is just how important recovery is. How it is contagious, and the essential glue for long-term change. We explore the importance of peer-led and community-based approaches, and not just the systemic reliance on core treatment. David is well-read and travelled, and he shares his reflections from not only being involved in the UK, but also globally, and in particular Australia and the US. I always enjoy my time and catching up with David. I leave the conversations enriched and hope you will too.
Our conversation is edited into 10 films totalling just over 64 minutes. A summary of each film is included below.
1. Introduction [1’36”]
Wulf welcomes David and reminds him that they first met in Glasgow at a Recovery event in 2009. They had several meetings in the city, convening with people like the late Rowdy Yates, David McCartney and Stephen Bamber. Wulf points out that there was a wave of recovery activity from 2008 to 2012 in the UK. He participated in the Recovery Academy that David set up. [NB. David’s camera on his computer then played up, and so he had to switch to his mobile phone for the rest of the interview.]
2. National Addiction Centre [6’49]
David describes how he worked with John Booth Davies, someone he holds in very high regard, on a Scottish Home and Health grant, which effectively got him his ticket to work at the National Addiction Centre in London, firstly at the Maudsley Hospital and then the Institute of Psychiatry. The move was great for him career-wise, as he went from research co-ordinator to Senior Lecturer in four years.
David found it fascinating working as a clinical researcher in large treatment services. He was able to observe at close hand an inpatient heroin detox ward, an inpatient alcohol detox ward, a very large methadone maintenance clinic, an emergency admissions ward, and an HIV ward. He later spent two years as head of research for the National Treatment Agency (NTA). He now recognises that he was able to watch the ‘industrialisation’ of treatment at the time. The industry paid a lot of mortgages and supported many people’s career development, including his own. But it didn’t benefit the lives of the people they were supposed to be helping.
The contrast between Scotland and England in the way they approached addiction recovery has always interested David. Scotland’s addiction recovery policy grew out of the strengths-based approach of the Scottish Mental Health Recovery Network. England’s approach was based on a harm reduction treatment approach, with a huge front door to treatment services and no back door. Many people were parked on methadone. The Blairite approach of just counting numbers entering treatment always struck David as wrong. The system was a mess. There was a major turning point after Paul Hayes, head of the NTA, ‘stuttered his way through non-answers’ in an interview with Mark Easton of the BBC, as to why no one appeared to successfully leave treatment.
David was always conscious of the fact that he and his fellow workers lived in wealthier London suburbs than those in which their clients lived. Staff had nothing to do with these poor suburbs. It was like he and his colleagues were trying to ‘sprinkle magic dust’ on the heads of their clients that would inoculate them for the next week or two, until they came back. Treatment was transactional and minimal.
Two important things then happened in David’s life. Firstly, he was invited to an inspirational 12-Step graduation ceremony at HM Prison Lancaster Farms. He witnessed a level of emotional intensity and gratitude, along with a collective feeling of empowerment and belonging, that he had never seen at the so-called centre for excellence, the Institute of Psychiatry. Secondly, David attended a talk given by leading US recovery advocate William White at the Scottish Parliament. To David, the talk was revolutionary. He was later appointed the first Chair of the Scottish Drugs Recovery Consortium, just after moving back up to Scotland. There, he experienced a grassroots explosion of enthusing and energy for recovery. The Serenity Cafe in Edinburgh was one of the exciting new initiatives.
Today, David sees pockets of recovery innovation, excellence and inspiration that are shining lights in an otherwise largely dark landscape. Wulf points out that he couldn’t agree more with David, and that is why he and I (David Clark) are highlighting the work of recovery communities on Recovery Voices.
3. Addiction Recovery and Treatment [8’06”]
David points out that whilst there is some ‘incredibly inspiring stuff’ going on in the recovery field, people in the next town don’t know about it. There is a real communication challenge. He’s often asked in communities if they should open a recovery cafe, but he points out that they should be more imaginative and do something different. In Newcastle, they are thinking of opening a sober sports bar where people can watch their beloved football while drinking alcohol-free beer. Wulf points out that the recovery group in Rotherham play snooker, as the sport is big there. In Bangor, they walk in the mountains.
David believes there is a real challenge about the science of recovery because it doesn’t include the same principle of replication as when designing a detox, for example, because it’s so reliant on social networks, context, assets and resources. What’s good for Wrexham is not necessarily good for Colwyn Bay. He mentions Calton Athletic Recovery Group, set up in Glasgow by the late David Bryce (‘Brycie’).
There is a kind of sneering about recovery by addiction scientists, says David. Recovery is considered to be all about God and wishful thinking. If recovery happens, it’s a rare thing and not worth studying. Pharmaceutical companies aren’t interested, so why should us scientists care? This is a real frustration for David as his main work has been centred around recovery capital. Globally, there are probably only about six people working in that area. Academics aren’t interested, partly because of a lack of funding.
Back in 2007, there was real feeling of hope and excitement in Scotland with the Road to Recovery policy. The Scottish Service Recovery Consortium acted as a catalyst for a lot of recovery-related activity, which was really exciting. The situation was very different in England, particularly in the post-NTA world, with the advent of large charities, decommissioning of lots of services, loss of funding, and all sorts of austerity miseries. Despite this, there was still a significant growth in the recovery world over the next decade.
Wulf believes only Scotland that had any type of recovery footprint. In Wales, there were only two pockets of recovery activity, one in North Wales in which he participated, and the other in Cardiff led by Sarah Vaille. The Welsh government was not involved. Wulf describes England as having fragmented chaos.
For David, the English system remains ‘all show and no action’ in regards of recovery. One of the insidious things that has happened is what he describes as ‘funding or commissioning candy’. Services, calling themselves ‘treatment and recovery services’, employ or have as volunteers a couple of people in early recovery who they send out to ‘tick those boxes’. Wulf points out that organisations are changing their names so they can sweep up any type of money—‘We Are With You’ or ‘Change Grow Live’. You may as well call an organisation, ‘Anything You Care To Fund Us For’.
When David worked in Melbourne, Australia, in the mental health recovery movement, they had a great term: ‘spray on recovery’. Nothing had changed other than use of the word ‘recovery’ for everything. He also describes another level of cynicism within the system. As a token effort, a few people in recovery are appointed who are dangerously isolated and not supported.
Despite all these problems, David and Wulf agree that some of the services do some really innovative work.
David got really excited in 2010 when the new drug strategy came out. It used all the right recovery terms. However, since then, it always got diluted down from the draft stage, so by the time it got to the implementation stage, you may as well say ‘business as usual’. There are whole groups of people who are responsible for maintaining the status quo, including his former employers at the National Addiction Centre.
4. Why the Recovery Field? [8’07”]
Wulf asks David what has motivated him to stay working in the field, helping foster knowledge and understanding about recovery and also supporting communities, when the money and support is not necessarily the best place for him career-wise. ‘Pure selfishness,’ David replies. He found working in methadone maintenance clinics and inpatient detox wards to be remarkably depressing and miserable. Doing research in a place where you have to come up with your £10 voucher to get people to talk to you, and then have the person say soon after that they have to go because someone is waiting for them. David also questioned the credibility of what he was being told by his ‘subjects’. He believes that sticking drugs into people is probably not that good for them either, and even may be unethical.
Soon after attending William White’s talk in Edinburgh, David asked Deidre Boyd if he and Ed Day could give out a questionnaire, asking people about their recovery journeys, at a UKESAD conference in London. They were overwhelmed by the response; many people wanted to tell their story. David now believes that in doing recovery research and doing addiction research, only one is good for your health. Being surrounded by people who have transformed their life is special. He also points out that several of his closest friends, and people he most respects and admires, are people in long-term recovery. There is a serenity and purpose about them that most of us don’t have.
David also felt that he could no longer be part of the industrialisation process of treatment. It has been an uncomfortable journey for him going from being one of Sir John Strang’s protégés, and the youngest senior Lecturer at the Institute of Psychiatry at the time, to not wanting to be part of that system anymore. Since he moved out of that field, he has felt very much an outsider. It has been easier for him working in Criminology Departments than in some other places. [Some of you will know that David has moved universities a number of times.]
Wulf points out that he often wonders whether he would have survived in academia if it wasn’t for the fact that he is first and foremost a social worker, and has actually come from a social work and sociological perspective, rather than a psychological and psychiatric perspective. He also points out that I (David Clark) changed from being a neuroscientist to a recovery advocate, a dramatic career change. ‘A turkey voting for Christmas,’ David says. He has felt like that at times.
David points out that when he moved to Melbourne in Australia he was very fortunate to meet Dan Klugman, a wonderful and inspirational figure who is not a part of the traditional clinical orthodoxy and is very critical of standard treatment models. He is happy to go for critical, challenging and innovative ways of thinking. David briefly describes some of the services he and Dan set up in Melbourne, including the Recovery Academy which was hosted at Turning Point.
David considers himself an academic traveller who has found a few flags of convenience at academic ‘homes’. He is cynical about addiction treatment services and especially about addiction science. And even more cynical about universities. Wulf agrees that universities have followed the same path of commercialisation as seen in the addiction treatment field. Years ago, they used to be places where unique characters like John Booth Davies could flourish.
5. Recovery Capital [8’43”]
One of the major developments in Australia for David occurred around the social identity model and social theory. He considers himself at heart a social psychologist, although he’s not sure the field of social psychology would have him. When he moved to Australia, David was absolutely savaged by Alex Wodak and other harm reductionists for being a carrier of that evil disease of recovery that wasn’t wanted or welcome in the country. (The latter was not David’s experience on the ground.) He was considered a dangerous outsider carrying an evil message. They were full of the traditional criticisms about recovery.
Social identity theory gave David a useful framework for shaping some of his work. He had also started to engage with William White and then Robert Granfield—the latter is known with William Cloud for their work on the concept of recovery capital. David has a book called The Recovery Capital Handbook coming out in April, for which Robert Granfield and William Cloud have written the first chapter and William White the introduction.
One of the reasons for working with recovery capital is that it gave David and colleagues a metric, something they could use to count things. In his earlier days, David had been one of the developers of the Maudsley Addiction Profile (MAP), a traditional treatment outcome measure. He points out that one of the problems of this measure is that it works on the assumption that perfect treatment only leaves you asymptomatic. It only measures reductions in deficits, what is wrong with you. Neither the MAP nor the Addiction Severity Index (ASI) give you any idea of whether someone has gained something and is flourishing. The aim of a therapeutic community or a 12-Step group is something very different, more complex. It’s about concepts such belonging and flourishing, positive aspects about life. People using the treatment outcome measure instruments are not interested in these positive sorts of measures.
David points out that what this means that people using the latter tools, the MAP and ASI, are able to say that the outcomes they get from acute treatment services are much better than those obtained in aftercare groups, therapeutic communities and recovery groups. However, they are measuring different things.
In developing a recovery capital measurement tool, David was able to measure positive aspects of life. Incidentally, he says, that if we use such a measure in methadone maintenance clinics, scores generally go down over time. People in the dreadful methadone maintenance clinic in Camberwell may be less likely to die, to get arrested and to get a blood borne virus. However, their quality of life generally goes down.
Through an introduction from William White, David started to work with Alexandre Laudet and they produced a paper for the Royal Society for Arts in 2010 on recovery capital. This project got David thinking about how we can measure recovery capital. That was the beginning of 14 years of work of developing and refining measures and metrics based around recovery capital. As an aside, it is likely that David will pass 250 peer-reviewed journal publications next year. He points out that this kind of output keeps the university paymasters at the door.
Wulf emphasises that the essence of the work David has been doing is that recovery is more important than treatment. The latter has a deficit-based accounting. However, if your life is shit and drinking makes it less shit… when you stop drinking, life is still shit. There is something beyond treatment that is more important to the individual and is life-changing.
6. Inspiring US Recovery Initiatives [5’35”]
David recently visited an exciting project in Albany, New York, called Second Chance Opportunities, which is a recovery housing organisation with 88 beds for people recovering from addiction. They also have a social enterprise which is a janitorial service. Their philosophy is that in your first year of recovery you get a job and avoid mixing with people who are not in recovery. You work in office buildings only. New York has a wonderful preferred grant status, which makes it very hard for non-charities to provide workers for government office cleaning, and gives opportunities for social enterprises like Second Chance to provide jobs for the people they are helping.
Second Chance’s idea is that it doesn’t matter what job you’ve done earlier. Even if you were a lawyer or doctor, you have to clean an office for a year. It’s a job that isn’t going to cause you stress or lead you to temptation. It allows you the time and space to develop basic qualities required to maintain your recovery. Of course, Second Chance recognises that this is only the first stage of a person’s recovery journey. Their philosophy centres around the idea of job (cleaning), then career and vocation. David loves the idea of linking up housing and jobs. As an aside, he mentions that the UK has really created an appalling mess with the recovery housing side of things.
One of the things that David has struggled with is: ‘What what would an optimal model look like of the process of transferring from specialist acute clinical treatment services to recovery services?’ Or, as William White would argue, as recovery precedes treatment, how do you create a system where you go to recovery services first and then subsequently engage with specialist acute treatment services?
Wulf points out that this is what he calls a classic peer sandwich. ‘You want peers all over the harm reduction community, keeping you alive, engaging you, and bringing you in.’ At a certain stage, a person may need some specialist treatment, but you need peers on the other side of that. David points out that it’s not even like a classic sandwich, as even the filling has to have bread in it. What you need is some kind of inspirational peer guide/mentor before you go anywhere near a clinical service. You want someone holding your hand while you are dealing with that ‘nasty’ doctor business.
One of the most exciting places that David has been to in the last few years is Chesterfield County Jail in Virginia, where they have a Therapeutic Community (TC) in the jail. The sheriff there looks like Boss Hogg from the TV series The Dukes of Hazard, walking around with enormous guns. He breaks Virginia state laws in that he runs an entirely democratic TC. None of the staff decide who can go into the community or get chucked out; it’s all peer-based decision making. What’s more, when people finish the drug programme in the jail, they don’t go back to the jail wings as they do in the UK. If you graduate from the TC, you go into one of three recovery houses in the community, where you continue to do your drug testing and the like. You also go back into the jail one day a week to continue the TC programme. You carry the message into jail of what it is like in the outside world. David asks why the UK is so rubbish at these sorts of things.
7. Four Recovery Quadrants [7’44”]
One of the things that David loves about the Lived Experience Recovery Organisations (LEROs) and Inclusive Recovery Cities is the idea of success and inspiration. He praises Chris Sylvester and his Getting Clean recovery initiative, which is located in Leeds. Getting Clean is a social enterprise for soap making. ‘Recovery soap, soap with hope, fighting crime and grime one bar at a time.’ Chris runs workshops in prisons and they organise soap-making events. He employs a number of people.
David summarises the evidence from all of the research about what is important for recovery: jobs, friends and houses, or somewhere to live, someone to love, and something to do. When David and his colleagues run their Recovery Cities workshops, they encourage individuals and groups to engage with four quadrants: sport, art and recreation; employment, training and education; volunteering and community involvement, and mutual aid and recovery groups. They argue for involvement in at least one item of each of these four sectors.
David was recently giving a similar talk in a prison between Wigan and Bolton. They do great park runs. The Fire Service comes in and runs fire training for prisoners. David and colleagues are now thinking about linking the latter to heath screening about sport and fitness, and to apprenticeships with the Fire Service. For David, the key question is: ‘How do you create multiple, personalised pathways for people that allow you to then create models of opportunity?’ Here is a prison with multiple challenges, but has such exciting and inspiring initiatives. They have Manchester City club conducting football training in the prison.
Wulf loves the idea of the four quadrants. One cannot prescribe fixed things for a recovery initiative, like you can for a methadone clinic, but you need to have things that ensure that people help other people, and that address practical issues that people have, such as housing and jobs. David points out that he would hate it if there was ever an ‘Orange Guidelines Book’ for Recovery. Wulf states that he was grateful recently to be asked to give a talk where he could once again reiterate that commissioning and recovery don’t go together. You can’t commission recovery.
One of the exciting things about LEROs, David reflects, is that they can have central hubs where under the same building you could have AA, NA, Al-Anon, Smart Recovery, Recovery Dharma, Women for Sobriety, as well as coaching five-a-side football, knitting, pathways to college, and a multitude of other things. It’s a ‘hub and spoke’ model. It’s important to bring in outside organisations that have nothing to do with recovery, and also get people out of their normal environment.
The last time that David visited DATUS in Birmingham, a peer-led recovery group founded by James Sadler in 2007, they headed up to Lickey Hills Country Park. Most of the upkeep of that park is now done by DATUS, as there are too few employed rangers. DATUS has contracts from Birmingham City Council to do that stuff. A mini-bus takes recovering people from various parts of the city to a beautiful country park located about ten miles away.
Wulf loves the ‘hub and spoke’ idea. He sees recovery communities or LEROS as typically being groups of around 50 to 100 people who know each other and physically assemble together once or twice a year, but for the rest of the time are going off doing pockets of stuff in groups of five to ten. They are not doing everything all together all the time.
David says that in the early days of recovery it is probably good to spend most of the time with other people in recovery. Stay in your recovery bubble, until you’re safe and ready enough to interact with the wider world. But if someone several years down the line has no social networks outside their recovery world, then something has gone badly wrong. David believes that recovery groups should eventually become a safety net, rather than a central feature for someone recovering from addiction.
8. Be Careful Overgeneralising [2’43”]
One of David’s PhD students, Shinasa Shahid, has been comparing the recovery journeys of black, Asian and white women. Recovery scores for Asian women were slightly odd for two apparent reasons. Firstly, the Asian women were further along in their recovery journey and were not using as much recovery support. Secondly, in most areas there was nothing culturally appropriate for Asian women in the way of peer recovery support groups.
David took his wife to the Recovery Games in Doncaster in 2023. It was a memorable occasion with over a thousand people at the event. David’s wife, who is American, commented that it was a fabulous event, but there were few women there and virtually no-one of colour. David emphasises that one of the dangers of recovery stuff in the UK is we sometimes forget that most of the population we are dealing with is mainly white, working class male, in the 30-50 year age group, and experiencing problems with alcohol or opiates. Wulf points out that this is the same population mainly accessing treatment.
Beth Collinson, a former PhD student of David’s, is now Head of Research for The Phoenix, a recovery organisation in the US. Her PhD was about community recovery and one of her major findings was that women in Sheffield were less likely to wear the t-shirt of recovery. They were more likely to quickly want to be involved in the Sheffield Fishing Club, but not in the Recovery Fishing Club. David and colleague have not replicated this finding, but he thinks we need to be cautious at times in over-generalising about recovery and the visible recovery community.
9. Activism, Not Science [6’21”]
Wulf points out whilst there is still stuff we don’t know, we do know an awful lot more about recovery, and recovery groups and communities, then we did 20 years ago. David believes that this is a very important point. Twenty years ago the recovery evidence base was patchy and weak. Today, his main recovery capital measuring instrument, REC-CAP, has been used with 20,000 people. If you want state funding in Michigan, Maine or Virginia it is mandatory that you use this instrument. David has 14 publications focused on REC-CAP. In this instrument, strengths are used as an outcome indicator and as an evaluation mechanism.
David emphasises that the depth of recovery evidence is growing internationally. He was in Singapore for a week training prison staff about the principles of recovery and long-term recovery. The day he got there over 9,000 people participated in the Yellow Ribbon Prison Run, an initiative focused on giving inmates and ex-offenders a second change to turn their lives around and contribute to society.
However, whilst David points out that the evidence base is good, he believes we still remain in our little bubble. We need to think much more about the crossover to mental health and to criminal justice. We should maybe stop thinking so much about recovery as a movement or a phenomenon, but as part of a kind of strengths-based revolution in social sciences. Wulf agrees that there was a great deal of fervour about a recovery movement in 2008-9. Today, many people now recognise that it is about long-term, localised, hard graft. Year after year in the same place. It is centred and grounded in communities.
David believes that the reason why there are not many recovery researchers is that you can’t be a recovery academic in the same way you can be an addiction academic. In the recovery field, you must be a passionate champion, an activist. You have to build trusting relationships. He says he doesn’t need to tell Wulf this, as the latter has been doing it for years. David doesn’t have any pretence that he is some sort of independent, neutral observer, He hasn’t been this for years.
The inspirational figure for David is still William White. The latter has always had a slightly odd relationship with traditional academia. He’s always been a big part of the recovery movement. David believes that traditional academic metrics don’t really work in the field. The big question is how do we communicate out to the field what we do.
He describes a Recovery Pathways Horizon 2020 project in which he and his colleagues looked at recovery in the UK, Holland and Belgium. Along with David Patton, he created a MOOC (Massive Open Online Course) based on that study, a six-session video online training course. This course has had a greater impact than virtually any of his academic publications. People at various international conferences have told him that they loved the MOOC. David believes we need to be doing more of this sort of stuff, along with blogs and podcasts. Wulf points out that he is why he is doing this Recovery Voices project, rather than spending more time writing.
10. Looking Beyond the Individual [8’30”]
Wulf points out that one of the problems for the recovery field is that some people are looking for some kind of standard output or outcome measure, like in the treatment field. However, they are not going to get anything meaningful with this mindset. He often tells people that one of the good markers of recovery is the ‘return to the family Sunday dinner’. When has anyone ever seen these words on a recovery outcome form?
David has just submitted a funding application to the Commonwealth of Virginia where one of the measures of recovery will be changes in the intergenerational transmission of addiction and crime. He refers back to 2010 when William White quoted two small qualitative studies that showed when fathers achieved sustainable recovery, their sons had better scholastic engagement, attendance and milestone achievement. David thinks that we make a mistake if we use an outcome metric that only focuses on a single individual.
He is currently writing about what the evaluation and outcomes should be used for the Inclusive Recovery Cities. He loves the book The Great American City by Robert Sampson, which is based on the Project for Human Development in Chicago Neighborhoods, a massive US study. Sampson uses the term collective efficacy, which refers to two things. One is social cohesion in communities, and the second is shared expectations about the likelihood of your neighbours getting involved in pro-social activities, like stopping somebody graffitiing. David wants to use collective efficacy as the metric for Inclusive Recovery Cities.
Wulf thinks this is a fascinating point and gets to the heart of all that is being done. In talking about recovery organisations or recovery communities, we do more than just focus on the individual. It extends into the family and wider society. For too long in the addiction and criminology field, we have been focused on fixing the individual. David states that we must fight the pathologised, diseased body, model. He points out that it is really all about connection, engagement and giving back. As an aside, he points out that James Sadler of DATUS rejects the ‘giving back’ phrase. He uses the phrase ‘reciprocal altruism’. Lots of his folk have no reason to have to give back. They have skills and talent and it’s a fair exchange.
Wulf points out that much of their Recovery Voices conversation today has been about challenging orthodoxy. Actually, it’s about reclaiming some orthodoxy—that community and people are at the heart of what humans do. In many ways, some of what’s gone on in the second half of the last century and the early part of this century has been about disconnecting people from community. David points out that one of the ambitious aims of Inclusive Recovery Cities is to say: Can the connectedness of recovery communities inspire similar changes more broadly across the wider community? Can they be the glue or the inspiration for re-engaging a range of excluded and marginalised groups and individuals?
David reminds us that one of the things that professionals in the recovery field do is underestimate the people, and their capabilities, with whom they work. If we think about outcomes for recovery groups and communities, we need to be much more ambitious and say that it has a footprint that goes beyond individual wellbeing. Wulf agrees. What is going on has the power to help contribute to the regeneration of boarded-up high streets and all sorts of other things. David says you only need to go to Barrow-on-Furness or Kendal where Dave Higham inspired the Wells Social Supermarkets. They are fabulous, not just for providing things for people in recovery, but contributing to the whole community. Making the community a better place for everyone.
Wulf points out that at the beginning of their conversation, David talked about treatment being too transactional. The power of recovery is that it can be transformational. This distinction is really important.
David’s Main Films YouTube Playlist
David’s Theme Films Playlist
Biography
David Best is Professor of Addiction Recovery, and Director of the Centre for Addiction Recovery Research (CARR), at Leeds Trinity University. He holds various other senior academic posts internationally. He is a founding member of the College of Lived Experience Recovery Organisations (LEROs) in the UK and of the Inclusive Recovery Cities movement.
Trained as a psychologist and criminologist, he has worked in practice, research and policy in the areas of addiction recovery and rehabilitation of offenders. He has authored or co-edited seven books on addiction recovery and desistance from offending, and has written more than 240 peer-reviewed journal publications and around 70 book chapters and technical reports. He is one of the leading academics in the area of addiction recovery and a key innovator in developing recovery capital measurement tools and methods.