The ‘New Recovery’ movement in Victoria
The first guest article published to Stonetree offers an insight into an anonymous Melbourne based AOD worker’s very frank reflections regarding the evolving recovery discourse in Victoria. While some may regard this article as divisive, I think it is highly representative of the confusion and concern in relation to the current discourse here, and presents an opportunityto engender frank, yet respectful discussion. A very big thank you goes out to Anonymous AOD Worker for submitting this article.
The New Recovery Movement in Victoria
In the interests of full(ish) disclosure (I am hiding behind a pseudonym after all), I have no authority on the topic of Recovery or the ‘New Recovery’ movement. I am not in recovery myself, have had little direct contact with the movement and have been, at best, a casual observer of its increasing influence in recent years. Until a few weeks ago, my views about Recovery and the new movement have been entirely shaped by the opinions of colleagues with a more sustained interest in the topic and, more directly, by conversations (in therapeutic and research roles) with people who have included mutual aid groups as part of their own support networks.
My recent interest in the movement has been driven by the commencement of a concerted campaign to promote New Recovery as the new paradigm for addressing alcohol and other drug (AOD) related concerns inAustralia, following the lead of developments in theUSAandUK.
Understandably, this has drawn a range of responses from those within the Australian AOD sector, many of which have been reflected in a recent draft ANEX discussion paper. It has been in the context of helping to draft a response to this paper by the agency I work for that I have begun to pay closer attention to New Recovery and to try to understand the core differences between its approach and those currently in place underAustralia’s Harm Minimisation framework.
To try to get a handle on what all the fuss is about, I’ve studied the work of people such as Stephen Bamber, William White and David Best and spoken to a range of people who know more about Recovery than me (and that’s just about everyone, including the distinguished Mr Stonetree). As a result, I’m left feeling pretty confused and more than a little concerned.
Before any of you start wheeling out what seems to be the default defence against criticism of the movement, my concern is not driven by self-interest and my desire to keep myself in a paid position within the publicly funded AOD treatment sector. If there is clear evidence that the Harm Minimisation approach is ineffective and needs to be replaced by a new model that does not need me in it, I am quite happy to find another job, in a different sector, where I’d most likely be getting paid more than at present.
The problem I have is that there is no clear evidence. In spite of the intuitive appeal of the New Recovery discourse, the weight of local and international research evidence is overwhelmingly on the side of Harm Minimisation as an overarching approach to keeping people alive and creating opportunities for immediate and long-term behavioural change. The apparent refusal of key New Recovery advocates to address the full implications of this for their position, while continuing to present New Recovery as a panacea for the world’s AOD problems, is one of the things I find most disturbing about the current debate.
The growing sense of unease I felt as I started my reading crystalised around a couple of revelations from William White in his Dialogue with Stephen Bamber on ‘Recovery-Oriented Methadone Maintenance’. Within what is a brave and thoughtful account of White’s change of position on the value of methadone maintenance, he drops a couple of bombshells that left me stunned.
For those of you who are already familiar with the monograph, they may not appear so sensational in their implications but, for me, as a Recovery noob, their impact has made an indelible mark.
In describing the evolution of his position, White describes his early attitude of, ‘great animosity toward methadone as a result of my enculturation in drug-free therapeutic communities’ (p4). He goes on to describe how this attitude started to change:
“when I went back to school and was forced to review the scientific evaluation of MM, but even at that stage [my attitude] could be depicted as a begrudging intellectual acceptance of the value of MM for some people. In my gut, I still had deep reservations about MM.”
He reports only coming to accept methadone maintenance as a legitimate Recovery support on hearing the stories of many people who had successfully combined it with New Recovery principles to achieve long-term changes.
As a story of an individual’s personal growth, it is a good one and powerfully told. What caused my jaw to drop was White’s comment that, after 40 years of working in the addiction treatment field:
“The biggest surprise I had in researching the history of MM is that its scientific effectiveness had been established in spite of the absence of important recovery support ingredients as MM was mainstreamed in the US and internationally.” (p5)
I’m still not sure what shocked me more about White’s account, the fact that someone who had been involved in AOD treatment for so long could remain so ignorant of one of the largest and most established bodies of research in the field or that one of the New Recovery movement’s more progressive thinkers is still so blinkered in his thinking that he appears unable to conceive of the possibility of effective treatment outcomes outside the New Recovery paradigm.
This is the issue that I find the most troubling about the New Recovery discourse: the unquestioning assumption of Recovery’s primacy, regardless of considerable evidence to the contrary. The messianic fervour that runs throughout this discourse – that New Recovery is the true AOD saviour and that all other approaches should repent their sins and bow down before it – reflects what appears to be a strong anti-intellectual, heart-over-head, ‘gut’-based pseudo-spiritualism that is at best, uninformed and, at worst, downright dangerous if enthroned as the sole basis for public AOD policy.
My distrust is not of Recovery principles (apart from the insistence on abstinence as the ultimate goal for all people using AOD), but with the ‘movement’. Not the movement as a whole, but the concept of New Recovery as a unified voice and, in particular, those proselytes who claim to channel it.
There is much more in common between the New Recovery and Harm Minimisation philosophies than there is difference. Both have essential contributions to make in the overall effort to reduce the burdens borne by individuals, families and the wider community as a result of AOD use. Through frank and open discussion, both can have positive influences on the other and foster the development of a truly integrated framework of mutually reinforcing approaches that are evidence-based, consistent with people’s lived experiences and, most importantly, effective.
What I have seen and heard from the movement to date is neither frank nor open. It seeks to reassure and be all things to all people, when it clearly is not. It seems unaware of its blind spots and becomes dismissive, evasive or combative when probed on them and that makes me nervous.
I have other concerns, (such as the apparent irrelevance of New Recovery for the great majority of people who use AOD and don’t identify as having a significant problem), but I’ve probably been banging on for long enough already. I’m happy to be proven wrong, or labelled a Harm Reduction Henny Penny, but my head, and my gut, tell me I’m onto something.
For me, the greatest hope for real progress comes from people like Neil Hunt, who prioritise the recognition of people’s individual needs and the provision of holistic supports (incorporating both Harm Reduction and Recovery approaches) to achieve real and sustainable outcomes.
Perhaps as he suggests, the terms Harm Reduction and Recovery are both redundant. and what we need is to focus less on fighting over labels and territory and more on providing effective supports that help people make the changes they want.