Divisions along a new road to addiction recovery

‘‘One drink’s too many and a thousand’s never enough.’’

This has been the mantra for people struggling with alcoholism, warning them against the dangers of having ‘‘just one’’. But what if you had a drink problem and could still have the occasional beer? Could a heroin addict continue to shoot up and consider themselves on the road to recovery?

As Australia grapples with the rise in illicit drug use and a binge drinking culture that shows no signs of abating, a new breed of addiction specialists are reshaping the way we view this complex and insidious problem. Born out of the United States, and also burgeoning in Britain, the ‘‘recovery’’ movement aims to challenge community perceptions of addiction by not only publicly celebrating those working their way out of it, but by redefining what it means to be substance dependent. While still in the fledgling stages in Australia, it’s already causing division within the drug and alcohol treatment sector.

Its most controversial tenet is that abstinence is a personal choice not a necessity. What it means to be recovering from drug or alcohol abuse is, according to the movement’s guiding principles, ‘‘experienced and defined by the individual’’. In essence, recovery is a journey not a destination.

Proponents say it’s a fresh, non-proscriptive approach that takes addiction out of the shadows and offers more chance of success through empowerment and self-determination. But some addiction doctors are concerned that this ‘‘recovery is what you want it to be’’ notion is an ill defined philosophy that undermines traditional medical treatment by letting addicts set their own recovery agenda.

‘‘A big risk of this approach is that the patient no longer becomes a patient, they become a willing servant of their own outcome and therefore if they don’t do well it’s their fault and so you then have a situation where you blame the victim,’’ says Professor Jon Currie, one of Australia’s most prominent drug and alcohol specialists, who is the former head of addiction medicine at St Vincent’s in Melbourne, and now works in private practice. ‘‘It moves away from a medical health model and towards an idea that everyone can do this if they try hard enough. But addiction has complex neurobiology behind it, so for a lot of people if they could have stopped using they would, but they have a brain structure that doesn’t allow them to do this.’’

David Best, a recently emigrated Scottish addiction specialist now working with Turning Point Drug and Alcohol Centre in Melbourne, is leading the recovery movement here. He says critics misunderstand the model and place too much focus on the abstinence-as choice ethos. ‘‘We still say that your best bet is to be abstinent from your primary drug of choice, and if you possibly can be completely sober from psychoactive substances apart from medications, but it’s a personal journey so everyone will be different,’’ Associate Professor Best said. ‘‘The best evidence we have is the length of an addiction career is typically around 27 years from age of first use of psychoactive substance to five years in stable or sober recovery, so it’s a long journey and it’s really more about the journey and the quality of life than whether you happen to be abstinent at a particular time.’’

Kim Riley’s path out of addiction was a long and arduous one that she traces all the way back to that first sip of alcohol, aged 10. At her lowest point she was waking up in the middle of the night for a fix. The three bottles of wine she’d start drinking from breakfast time were never enough. Now a drug and alcohol counsellor, the 40-year-old from Parkdale has been sober for 3 1/2 years, and is an advocate of the recovery approach.

After trying moderate drinking following stints in rehab she ultimately decided abstinence was her best option, although she says she respects those who take a different path. ‘‘I still had in the back of my mind that I would have a champagne on New Year’s Eve. Some people might be able to be that social drinker but I couldn’t,’’ she says.

One of the approach’s other key principles is encouraging those who have struggled with addiction to go public with their experiences. Advocates believe that while traditional Alcoholics/Narcotics/Gamblers Anonymous 12-step programs have helped countless people, the insistence on anonymity may also have inadvertently exacerbated the shame and silence surrounding addiction.

Indeed, when Fairfax Media approached Alcoholics Anonymous Australia’s general services officer for an interview, he agreed but only if his name was not published. ‘‘We don’t want to be known as some secret, unknown society that doesn’t celebrate that we’ve found a solution that works, but we do ask that members don’t get in front of a television camera recognisable or nominate their name in a radio or newspaper interview. AA has a spiritual approach and we don’t want to big note ourselves,’’ he said.

Ms Riley believes sharing her story has played a key part in her conquering her addiction. ‘‘Not only does it make your own recovery stronger but it instils within other people the idea of hope, and as you watch them get better it reinforces the belief that your life is just going to continue to get better,’’ she says.

Recovery proponents say secrecy surrounding drink and drug problems, while arguably vital in the early stages of treatment to build trust among members at ‘‘tell-all’’ support group meetings, has also helped entrench stereotypes.

“The old guy on the park bench drinking whisky from a paper bag is the visible alcoholic, everybody sees him. The guy who’s a professional and living in Toorak is invisible but there are just as many of them, they’re just being hidden by their families,’’ says George Thompson, program director of Recovery Foundation, a Melbourne addiction treatment program that embraces aspects of the recovery approach. ‘‘The AA model works and it has helped millions of people, but one of the biggest drawbacks of those 12-step groups has been anonymity. Alcoholism and addiction in general is an illness. It’s a serious mental disease. Why are we anonymous about somebody who has a mental health problem?’’

The success of organisations such as beyond blue and headspace in de-stigmatising depression and mental illness has largely been driven by their ability to put people with lived experience in front of journalists and TV cameras. The subsequent shift in public consciousness has inspired those in the addiction space.

David Best hopes to have a similar effect with Recovery Academy Australia – an organisation he set up to support and celebrate people dealing with addiction. Based on events he staged in Glasgow, he started an annual ‘‘recovery walk’’ in Melbourne last year to publicly celebrate the journeys of those navigating the addiction pathway, and the friends and family who support them. The inaugural event attracted 400 people, and today the second walk from Federation Square is expected to draw an even bigger crowd.

This public affirmation is part of the recovery movement’s core belief that messages of hope have a social contagion effect. The visible presence of recovering alcoholics, gamblers and drug users coming together in a major city centre also challenges stigma and discrimination, he said. ‘‘It makes it apparent that yeah, addiction is a terrible blight but people do overcome it, they do get on with their lives. . .The notion of it somehow being this chronic relapsing condition that leads to degradation and death is unhelpful, for family members, and for the people who are going through it.’’

Another concern in the treatment sector is that governments will capitalise on the recovery model’s growing popularity by cutting back on addiction services in favour of cheaper recovery-based approaches. Already, there are signs that the Victorian government has been captivated by the approach. In its recently released four year plan to tackle the state’s alcohol and drug toll it promised to deliver a ‘‘redeveloped, recovery-oriented alcohol and drug treatment system’’. ‘‘So you get a relatively cheap service which provides some support and the rest is up to the family and the person and their support group,’’ Professor Currie says.

For Kim Riley, recovery is, above all, about hope. ‘‘It’s time to break that stigma and this is an opportunity for people to say you don’t have to keep going down that same path, you can turn things around and find success. I feel just really a part of life now, which is a feeling that I’ve not ever experienced before.’’

Source: jstark@fairfaxmedia.com ? Melbourne Age May 2013

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