Although for good academic reasons I am rather wary of the normative aspects of the term recovery I was pleased to see that in the new Drug Strategy the coalition government recognise that recovery is "an individual, person-centred journey" and that they'll support "medically assisted recovery" (MAR). Although I have only recently come across the term after reading the work of William White (1), Lisa Mojer-Torres (2) and Stephen Bamber (3) amongst others, I am quite willing to put myself in the category of persons journeying along the MAR pathway. But my relationship to treatment was not always thus.
I have been taking opiates in one form or another for a number of years, and for most of that time I have been scripted and either studying at university or in work. Granted, when I first got a script back in 1993, after I'd developed a dependence on over-the-counter medications during the final year of my degree studies in London, I perhaps should have been offered a detox rather than a script, but I had just started a Master of Arts (MA) at the time and this would have unfeasible. So, I got myself on a script and started to stabilise with the notion that I'd give up at a later date, after my studies. I hadn't thought about rehab as then, and for many years after, I had the belief that only rock stars and the rich had that luxury. This was, perhaps, confirmed when I went for my first inpatient detox at High Royds Hospital, a rather elegant former pauper lunatic asylum, latterly an inpatient psychiatric unit on the outskirts of Leeds. Great as it was - as I had enjoyed reading Foucault's Madness and Civilization as part of my Cultural Studies MA - it was not so great for me personally.
Unfortunately I had an adverse reaction to lofexidine and had to leave and return to my script after three days. My next attempt was a home detox with dihydrocodeine which I did for a few months, after which the addiction unit at Leeds bid me farewell and not long after that I moved back to London. However, although I wasn't then aware of the definition of addiction as a chronic relapsing condition, I found that I couldn't stop myself from traipsing around the many chemists in London purchasing anything with a codeine, morphine or opium content. I wasn't really made for the day to day use of street heroin and the culture around it, although I'd occasionally buy street methadone until I got another script sorted out, this time from the Drug Dependency Unit (DDU) in Camden. Again I found that with methadone I stabilised and got myself back to work. So what was wrong with methadone? At the time, for me, everything.
"I began to slowly reject my negative self-talk about being on methadone"
All I could see was the unwelcoming offices of the DDU based at the old Temperance Hospital on Hampstead Road with a lot of drug activity going on around it and the endless forms of control I had to submit myself to. Picking up every day, endless key worker visits, lack of spontaneity as I couldn't go away without giving my prescriber two weeks notice and, if I wanted to go abroad, having to choose a country that would let me in with methadone. It was tedious and boring. And this, I believed, was the function of treatment, to make drug taking as tedious and boring as possible so that you'd quit. But I didn't, I kept one foot in the world of the clinic and one foot in the street, topping up occasionally on street drugs and a rather nasty bout of bacterial endocarditis which left me with an artificial aortic valve and I ended up in hospital for almost 7 months. Sometime afterwards I tried quitting again at home, which worked for a while but then the same thing happened. Back on a script and working my way up the publishing sector ladder I got involved with Narcotics Anonymous (NA) despite being a committed atheist and having reservations about joining any group. I got a certain amount of support there and after five years on a script decided to go into rehab, still really being pushed along because I wanted to escape from what I saw as an institutionally unhealthy clinic system which has been documented so well by William White (4) in the United States.
I got accepted at a swish residential 12 step rehab in Wiltshire, and after six weeks of not exactly buying into the methodology, came out to no aftercare, apart from the little self referring I managed to do. You can guess what's coming next: in the middle of 2008 I found myself back on a methadone script and my only plans now were to get a job and wait a while. I consequently found myself interning at DrugScope in 2009 where for the first time I came across work on MAR which I devoured like a convert. I began to slowly reject my negative self-talk about being on methadone, and as I was in a supportive environment I was able to disclose that I was on medication and found I was not treated any differently. I'm currently on what these days would be considered a "low level optimal dose" and quite happy with it, so that when I do meet with my key worker once a month I usually have a chat about what I've been reading lately and the current concerns in the treatment sector. I'm still with the local drug team but I'm currently looking into shared care as an option to free up more of my time.
The UK treatment system, and from my experience the mutual aid groups such as NA, are a long way from the US in accepting MAR as a treatment model for those who wish to go down that route. Medication-Assisted Recovery is a model of recovery which differs from the abstinence model in that those who are stable on a range of medications such as methadone, buprenorphine, and morphine are able to participate in the recovery movement. The UK has been rather slow in taking this idea forward whereas the US has several years of establishing this model. It works along with the usual recovery supports such as counseling and peer support. Although these medications are not a cure to dependency, they do help thousands maintain a fruitful and enjoyable life and play a role in helping people begin and sustain recovery. GPs may find Stephen Bamber's Infographic on Medication Assisted Recovery of use (5).
Methadone is still a highly stigmatised medication and it's going to take a lot of pushing and shoving to get the rights for those in MAR upheld. Through The Alliance (6) and other user groups you hear stories of Drug and Alcohol Action Teams invoking time-limited scripting, or removing injectables for those who need them against all the evidence to the contrary. And in the realm of employment there should be legislation to prevent discrimination against those on medications related to drug dependency or in recovery in general. I've been working on the stigma report for the UK Drug Policy Commission and it doesn't make for optimistic reading (7).
I'm currently trying my utmost to support groups working for users' rights, and I'm involved in Frontline, the Camden service users group and working with INPUD. I did, however, find myself err quite recently. I was having a sight test at the local optician and was asked what medication, if any, I was currently taking. I thought for a millisecond or three and replied, "ah, none...". A luta continua* as they say.
*The struggle continues
4. White, W. (2009) Long term strategies to reduce stigma attached to addiction, treatment, and recovery within the City of Philadelphia. Philadelphia: Department of Behavioral Health and Mental Retardation Services