Interview with David Best
What is in a name?
There has been a lot written about recovery in recent years in Australia and elsewhere, and just like the climate change debate there appears to sides forming on the understanding of what recovery actually is or means. Grogwatch talks with Associate Professor David Best on what recovery means to him.
GW: What is recovery about?
DB: The first core aim of the recovery model is to create visible and dynamic networks of recovery champions in local communities who celebrate recovery and who create inclusive and open support networks that can engage and attract those who aspire to long-term recovery. The second is to entice alcohol and other drug (AOD) professionals to be actively engaged in the community activities that create the belief that recovery is possible and the assertive linkage (TImko et al, 2006) that will enable people in treatment to access community supports. Thirdly, it requires policy makers to re-conceptualise addiction as a chronic relapsing condition from an interpretation of hopelessness to a recognition that recovery is not easy. It is a long-term change process involving individuals, workers, families and communities working together to embody the CHIME acronym (Connectedness, Hope, Identity, Meaning and Empowerment) and to overcome stigma and discrimination by promoting and celebrating the incredible achievement of recovery.
GW: Tell us about CHIME?
DB: In 2011, Leamy and colleagues published a review of existing recovery evidence and came up with an acronym—CHIME—to summarise common characteristics identified in research into recovery. Each letter of the acronym will be explored below:
CONNECTEDNESS: Putnam (2000) cites evidence that to reduce mortality risk in the next year, making a friend confers the same benefit as stopping smoking, while social support and belonging contribute strongly to quality of life in all populations. This also applies to people in recovery—adding one other person in recovery to the social network of someone completing alcohol detoxification reduces their relapse risk in the next year by 27% (Litt et al, 2007). In a summary of the core predictors of long-term recovery from alcohol, Moos (2011) suggested two key social factors—the influence of friends on behaviour and ‘social learning’—the critical role of peers in modelling recovery behaviours. Connection matters to all of us, and is crucial in recovery.
HOPE: While it is recognised that addiction is a chronic relapsing condition, lots of people do stop using AOD. Calabria et al (2010) conducted a systematic review of remission from use and reported that “Almost one quarter of persons dependent on amphetamine, one in five dependent on cocaine, 15% of those dependent on heroin and one in ten dependent on cannabis may remit from active drug dependence in a year” (Calabria et al, 2010, p747-748). Likewise, Whitter and Sheedy (2009) reviewed the evidence and concluded that, of all those who have a lifetime substance dependence, 58% will recover. Yet, when I asked 201 AOD professionals in North Wales to estimate how many people recover, the average answer was 7%. Hope is essential to change and introducing clients to people who have already gone down the same road is critical in creating the belief that change is possible. And do clients want this? According to McKeganey et al (2004) of over 10,000 clients starting treatment in Scotland, 56.6% reported that their sole treatment aim was ‘abstinence only’. That is what most clients want and the evidence suggests they are right to hope for that.
IDENTITY: McKeganey and McIntosh (2000) reported that one of the key characteristics of the transition from addiction to recovery is the transformation in personal identity. This is consistent with the Social Identity Model of Identity Change (SIMIC; Jetten et al, 2009) which suggests that social identity is critical to life transitions and, for recovery, this is about a sense of belonging and pride in the new identity.
MEANING: Part of the recovery agenda is about having a sense of purpose. In our work in Glasgow (Best et al, 2011), the strongest predictors of quality of life in recovery were how much time people spent with others in recovery and how much they did. The more time people spent in training, employment, volunteering, in group activity and in parenting, the better their quality of life. Dingle et al (2012) have reported the same thing for mental health. Recovery is about active engagement in the community.
EMPOWERMENT: Recovery has its origins in the consumer empowerment agenda and is about active participation of community and recovery groups in decision making and ownership. This applies not only to individuals in recovery but also their families as recovery is an inclusive model.
GW: Is this some sort of AA model?
Mutual aid groups have played a crucial role in the history of recovery but it is crucial that recovery as a social movement is seen as including but not restricted to 12 step groups. The recovery movement is an umbrella that will include SMART recovery, local community groups and people whose recovery involved no group participation and no specific philosophies. The recovery movement differs in two crucial ways from the fellowship—it is deliberately open and visible (promoting recovery through role modelling) and it is assertively inclusive—so targets not only those in recovery (however they choose to define that) but also family members, friends, community members and a diverse range of professionals. And of course those from the mutual aid fellowships.
GW: The critics of recovery are worried that funding will be linked to recovery and that recovery means ‘cured’ therefore treatment agencies may only deal with the easy wins, what do you say to the critics?
In my research, I have collected around 1200 recovery stories—and in less than 10% of these do people talk about being ‘cured’ or recovered. For most people it is a journey that is deeply personal and ongoing. I think there are two crucial implications of a recovery philosophy for policy—one that the focus should be much more on quality of life and social connection than on reduction in symptoms (and so clearly this means recovery is not restricted to abstinence). Secondly, recovery is something that is negotiated between the individual, their family and their community and so its definition is less reliant on professional endorsement and I think this has profound implications for policy and outcome monitoring.
GW: Why do we need a recovery model?
Recovery models are neither ‘new’ nor a radical departure from what has gone before. They are about breathing hope into parts of a treatment system that is at risk of burnout, and to offer methods of supplementing what can be achieved in formal treatment.
The community is at the heart of the recovery model and recognises some basic challenges:
- Aftercare improves treatment outcomes typically by around one third yet only 10% of clients receive adequate aftercare (Best et al, 2010)
- Treatment episodes are often of short duration and do not adequately address the long-term needs of clients in terms of meaningful activities, sense of identity or belonging in their communities (White, 2009)
- Many people aspire to and achieve abstinence yet little is offered to support the needs of those who achieve this goal.
One of the key aims of a recovery movement is to create a visible network of recovery champions who are based in the local community and who can work with treatment services and with the mutual aid groups to provide effective role modelling and social support. A core aim is a visible community of recovery champions who are easily accessed. Why?
In a study of gay men and lesbian women, Cole et al (1996) found that long-term concealment of their sexual identity was associated with higher rates of cancer and increased incidence of infectious disease. For people with an acquired brain injury, research participants who were more willing to disclose their injury to others were reported higher levels of self-esteem and life-satisfaction (Jones et al, 2011).
Thus, a key aim of the recovery model is to develop and support networks of linked community recovery champions including family members and workers in the AOD field who are able to be visible ‘champions’ of recovery challenging discrimination and meeting the social and positive identity needs of those who choose a recovery journey.
David Best is Associate Professor of Addiction Studies and is a joint appointment with Monash University. He is from Scotland and qualified initially with a first class honours degree in Psychology with Philosophy, before achieving a Masters with Distinction in Criminology. His PhD was about the explanations drug and alcohol users provide for their addictions and how this shapes their perceptions of what is possible in the future. He has worked in academic research at Strathclyde University in Glasgow, the Institute of Psychiatry in London, Birmingham University and the University of the West of Scotland. He has worked in policy research at the Police Complaints Authority, the National Treatment Agency and the Prime Ministers’ Delivery Unit.
Best D, Rome A, Hanning K, White W, Gossop M, Taylor A & Perkins A 2010 Research for recovery: A review of the drugs evidence base, Edinburgh: Crime and Justice Social Research, Scottish Government.
Best D, Gow J, Knox A, Taylor A, Groshkova T & White W 2011 “Mapping the recovery stories
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Cole S, Kemeny M, Taylor S & Visscher B 1996 “Accelerated course of human immunodeficiency virus in gay men who conceal their homosexual identity”, Health Psychology, 15, 243-251.
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