Joint Committee on Health and Children

Meeting

Thursday 26thMarch 2015

Opening Statement

by

Mr. Gerry McAleenan

Project Leader

Soilse

Health Service Executive

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Introduction

Thank you for giving us the opportunity of appearing here today to discuss the contents of a report, Addiction Recovery: A Contagious Paradigm. I will start by giving an overview of Soilse, the addiction rehabilitation service the report came from. I will then go through the main issues related to the report in a questions-and-answers format.

What is Soilse?

Soilse is the HSE’s daytime drug rehabilitation project in Dublin’s north inner city, established in 1992. It works with people who are either preparing to detox or who have completed a residential drug treatment programme and are in the early stages of recovery. Ourservice users are former heroin addicts.

What is the status of drug use in Ireland today?

In the 1970s, 1980s and 1990s, the drug abuse problem in Ireland was mainly one of opiate – primarily heroin – addiction. Today, however, peopleare using not just heroin but also benzodiazepines, alcohol and other drugs. This is known as poly-drug abuse.

Since the 1970s, the response has been to treat opiate addiction by substituting methadone for heroin. Known as the public health model, this seeks to reduceharm to society by:

reducing the need to commit crime to get heroin; and

eliminating the use of heroin and the sharing of needles. (Prescribing methadone and needles exchanges reduces the health risks associated with heroin addiction).

Currently, about 10,000 people are in methadone treatment, one third for more than a decade. Their struggles are captured in the case studies in “Addiction Recovery: A Contagious Paradigm”.

What can recovery offer?

In Ireland and internationally, there is an emerging focus on recovery from addiction.This view of recovery sees services being reframed around service users. Unlike the public health model, a recovery model puts service users at the centre of treatment and rehabilitation responses and looks to enhance their quality of life by involving them fully in their own care. This means reorientating treatment and rehabilitation services towards a recovery paradigm, recognising that service users’ voices are important, and enabling them to direct their own goals and so change and reframe their lives.

What evidence supports this approach?

The concept of recovery was first introduced into the addiction research literature in 1999 with the work of Granfield and Cloud. They showedhow 46 individuals were able to overcome their addiction independently of services primarily because they had what Granfield and Cloud called ‘recovery capital’(in other words,pre-existing jobs,qualifications, income,family support, social networks and a home). Subsequently, Cloud and Granfield published their theory of recovery. This comprises four elements:

  • Social Capital – relationships, supports, groups to which we belong
  • Physical Capital – property and income
  • Human Capital – education and skills, positive health and aspirations
  • Cultural Capital – values, beliefs and attitudes.

Focusing on these assets helps the person to build recovery capital. This approach has now been taken up inEngland, Wales and Scotland, and further afield as the main organising construct for addiction services.

Does Irelandwant to move towards a recovery framework?

Addiction Recovery: A Contagious Paradigm sets out the case in Ireland for a move to a recovery framework to deliver addiction services. Over a decade ago the midterm review of the Irish Drug Strategy (2005)showed that stakeholders felt that service users should not be kept on methadone indefinitely but assisted in ‘moving on’ towards recovery and social integration. The Report of the Working Group on Rehabilitation (2007) elaborated on this and signposted the key elements of social integration: housing, work and education. It said the overall aim of services should be ‘to maximise the quality of life, re-engagement, independent living and employability of the recovering problem drug user in line with their aspirations’ (p21).

In 2011, Martin Keane conducted research in Soilse and showed how an adult learning approach that fused education and recovery could help service users to develop recovery capital, progress in education into college and successfully move away from the drug culture.

The HSE Dublin North Addiction Service Review (2013) recommended this recovery-focused approach and the addiction services in Dublin North are putting in structures to enable recovery. In the review, recovery was defined as ‘a person-centredjourney enabling people to get a sense of control over their own problems, the services they receive and their lives and providing opportunities to participate in wider society’.

The National Drug Rehabilitation Implementation Committee (NDRIC) Evaluation (2013) also reviewed the mechanisms which would underpin a recovery approach and found broad support for them. So at both a practice and policy level there is a momentum building towards a recovery response in Ireland. Indeed, the HSE’s 2015 Primary Care Division Operation Plan says each service user should have a key worker and care plan that service users should be transferred from HSE clinics into GP surgeries, and that regular client satisfaction surveys should be carried out.

What are the principles that reflect recovery?

Addiction Recovery: A Contagious Paradigmdescribes in detailthe principles of recovery which give shape to the emerging framework. They are described briefly below.

Principles of recovery from substance abuse
  • There are many pathways to recovery.
  • Recovery is self-directed and empowering.
  • Recovery involves a personal recognition of the need for change and transformation.
  • Recovery is holistic.
  • Recovery has cultural dimensions.
  • Recovery exists on a continuum of improved health and wellness.
  • Recovery emerges from hope and gratitude.
  • Recovery involves a process of healing and self-redefinition.
  • Recovery involves addressing discrimination and transcending shame and stigma.
  • Recovery is supported by peers and allies.
  • Recovery involves (re)joining and (re)building a life in the community.
  • Recovery is a reality.

The principles are more accessible and inclusive than a formal definition of recovery, andconcur with the principles of health promotion and social inclusion.They come from Sheedy and Whitter (2009) and are based on 20 years of research and widespread consultation. They suggest that people from all walks of life are in recovery from addiction and that the benefits of recovery extend to their families, neighbours and communities.

How does recovery happen in other countries?

In England and Wales, Scotland, the United Statesand Australia, recoveryis now influencing national policies on drugs. Some responses include:

‘recovery academies’, comprising researchers, service users, families and community supporters. Theseaim to implement the principles of recovery and advocate for recovery;

recovery champions – these are positive peer models who show that recovery happens;

recovery coaches whogive advice and support around addiction or life issues;

fellowships like Narcotic Anonymous who provide ongoing support;

celebrations such as International Recovery Month which occurs in September (For instance, in England in 2014, there was an 8,000-strong parade in Manchester);

recovery infrastructure such as recovery cafes and recovery houses. For example,Birmingham’s local government has awarded over €1 million to develop a new facility called Recovery Central. This will open in 2015 and include a one-stop shop for recovery information and services, work experience, volunteering and employment opportunities, and community-based social enterprises such as furniture restoration, bike repairs, and so on.

How does this relate to Ireland?

Soilse is an example of a service implementing a recovery response. Soilse is part of the HSE Northern Area Addiction Services Continuum of Care which provides a recovery pathway for recovering drug users including stabilisation (Soilse), detoxification (Cuan Dara), drug-free residential treatment (Keltoi) and drug-free dayprogrammes (Soilse). Soilse is also involved in an innovative European Union Lifelong Learning programme called RECOVEU. This partnership is putting together a module to facilitate recovering drug users’ access to college.

Soilse also uses recovery coaches (trained by Finglas Addiction Support Teamand DublinCityUniversity), celebrates International Recovery Month (through workshops on recovery and social activities), and commissions research on the relationship between addiction recovery and education (Keane 2011). As part of the Northern Area Addiction Services we informed and comply with the 2013 review. Indeed, it was out of our learning that Addiction Recovery: A Contagious Paradigm was developed.

Recommendations

Many service users and service providers now see recovery as a viable option. Recovery offers hope and a vision for those caught in services long term. A recovery model will challenge fatalism and stigma around the drugs issue. Recovery also contributes to building inclusive communities and options for those who want to change.

Addiction Recovery: A Contagious Paradigmwas triggered by a 2012 symposium which brought together more than 100 people in recovery. The report reflects their views and is underpinned by the views of stakeholders and published research. In the four hours of discussion at the symposium, contributors spoke little of drug use but overwhelmingly of the challenges that confronted them and the lives they wished to live. The emphasis was on solutions, ideas that were practical, obtainable but also cost-effective. This points towards a strong case for the re-orientation of addiction services to a recovery paradigm.

This concludes my opening statement and together with my colleagues we will endeavour to answer any questions you may have.

Thank you.

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