A View from New York
Last Thursday I was invited to ‘Learning Thursday’, an addictions professionals’ seminar, at the New York State Office of Alcoholism and Substance Abuse Services. OASAS oversees the most diverse addiction prevention and treatment system in the US. It plans, develops and regulates the state’s system of chemical dependence and gambling treatment agencies and directly operates 13 addiction treatment centres providing inpatient rehab to 10,000 people a year. It licences, funds and supervises some 1,300 community based programmes which a further 115,000 people per day access and runs an inspection and monitoring division.
The session was led by the extraordinarily impressive Lureen McNeil, Director of Recovery Services and a former addict - she announced unblinkingly. She then described the female led families in which the addiction problem has now passed down through four generations, a profile that typifies New York’s addiction problem. In one appalling case history she showed the increasing vulnerability, psychological disturbance and dysfunction of each successive generation as final vestiges of familial support dissipated, how in the latest generation this has created the most difficult and disturbed cohort of young addicts they have ever had to help.
When the next speaker, Jackson Davis, the Director of the Recovery Network of New York, opened by stating that he too was a former addict, now in recovery for many years, my mind left his breakdown of criminal justice realities in the US: how many of his UK counterparts, I wondered, would be prepared to admit former addiction in public? And how, my mind went on, has continuing stigma and shame effected the development of policy in the UK? Is this what lies behind the continued dominance of ‘medico – clinical’ model of addiction and its negative connotations of a chronically relapsing disease? Has this view persisted because it has so rarely been openly challenged by those in positions of public authority but in private recovery? Is this ‘non recoverable’ view of addiction impregnable until doctors, treatment managers, counsellors and administrators or any other public figures, step forward and say, ‘yes, we too were addicts or yes, we too are in recovery, recovery is possible’?
For Jackson Davis and his federally funded Recovery Network the need to reduce the stigma of addiction is of first importance. And you can see why. Acceptance without examples is difficult. With examples it is inspirational. No wonder one professional there told me, “the recovery movement here is huge; we do not seem to make as big a deal about ‘abstinence’ versus ‘harm reduction’ as it seems the Europeans do.”
So while the UK remains locked in denial and a negative debate going nowhere, Lureen McNeil is charging ahead changing the social face of addiction in New York. Her goals are pragmatic - to reduce drug abuse, to improve patient’s ability to function and to minimize medical and social complications. If this means substitute prescribing for a while, she is all for it. But her goals are also aspirational. She will not be detracted from an overarching treatment goal of achieving lasting abstinence. She will not stop from communicating the message that recovery from addiction is peer based, not professionally directed by clinical services. She will not let pragmatism cloud her own experience and analysis of recovery – one that is primarily self defined and self directed.
Downtown Manhattan, at an inspired outpatient addiction treatment centre, I saw this philosophy in practice. The Director there was also a recovered addict. His mission ever since has been to help others reclaim their lives through a ‘non judgemental continuum of programmes and care’ and which represent a synthesis between ‘engaging’ clients (by giving them access to primary and mental health care, viral testing, medication and needle exchange) and ‘the therapeutic community”. I saw this symbolic and practical link in action - the clinic and nurses at one end of the blue and lavender painted building which connected by a corridor to peer led, abstinence based recovery programmes going on at the other. In one of them the men and women in the circle explained what the centre meant to them, the therapeutic effect for their recovery of seeing people everyday they knew and who understood them. They told of how this substituted for the families and supportive relationships they had never had.
This centre now has over 8,600 graduates from its recovery programme, employs 40 full time staff and has state funding to the tune of five millions dollars to run it and significant freedom to decide its own methods and programmes. A far cry from the UK’s state directed hegemony.
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