‘Full Recovery’ a flawed policy
As the discourse unfolds in Australia about the place of recovery in Victoria’s drug treatment framework, it is with some dismay that I read the so called ‘recovery roadmap’, “Putting Full Recovery First” released by the English Home Office.
Perhaps the most troubling aspect of a document that is littered with a litany of disasters waiting to happen is the proposed development of a payment by results model that incentivises recovery outcomes. In other words services that do not deliver what government deems ‘recovery’ outcomes will not get paid for the service they have provided an individual.
For example it may be identified that the provision of opiate substitution pharmacotherapy such as methadone may provide positive health outcomes for an individual. Services that do provide this service but fail to transition individuals off the pharmacotherapy will not get payment for the work they have conducted. This is problematic on a number of levels.
In some instances transitioning people off methadone or another substitution pharmacotherapy can often be a complex task requiring that the individual is stabilised in their substance use and that requisite supports required to maintain low risk (including potentially abstinence) are well entrenched. Failure to do so can result in relapse and potentially overdose.
Funding models that fail to account for the long term, holistic work required to adequately support individuals while still on a pharmacotherapy is both irresponsible and dangerous.
Such a model also predicates that complete abstinence is a requirement of recovery. One of my frustrations with previously available models of recovery in Australia is that all too often they were predicated upon complete abstinence. The broadening of the term recovery to include those who had made significant changes, that improved quality of life, was a great leap forward. It enables people who do not desire abstinence, yet who make significant changes to their life and to their drug use to celebrate the changes that they have made.
This maybe the crux of the matter. Recovery is a personal process with personally identified goal posts. Governments historically are bad judges of my personal goals and I am guessing that they don’t do much better with anybody else’s. Arbitrary funding models that emphasise an end outcome rather than the process will fail to deliver a recovery oriented service system. Even more concerning is that by financially emphasising a so called ‘full recovery’ model, the English government is in effect financially disincentivising harm reduction interventions that save lives.
In short, this English policy interpretation of recovery is a flawed document, failing to realise a truly recovery oriented alcohol and other drugs service system while at the same time effectively defunding harm reduction strategies that have been demonstrated time and time again to reduce drug related harms for both the individual and the community.