Treatment reform in the U.K.

A direct challenge to the U.K. reliance on methadone.

I find it pretty easy to imagine similar circumstances in the U.S. if it weren't for the numbers of recovering people already in the field and the good fortune to have high profile recovery advocates like Senator Harold Hughes and Betty Ford in the right place at the right time.

Another article deconstructs the U.K.'s definition of recovery and offers some context.

In particular, the inclusion of "sustained control over substance use":

...in talking about voluntary exercised control there is a sense in which the thorny issue of drug user abstinence has been effectively sidestepped. But how is control in this context being defined? Does this definition mean that an individual continuing to use illegal drugs but in a more controlled way can be considered ‘in recovery’? Does it matter in terms of evaluating the effect of services if that element of control cannot actually be defined or measured? Does it matter if, as a result of this definition of recovery, we will not know whether the control that is being exercised is increasing, decreasing, or remaining the same over different lengths of time in treatment?

Aside from the difficulty of measuring the element of control, there is also the question of whose definition of control is going to apply in assessing whether the individual is indeed in more or less control of his or her drug use – that of the drug user, the doctor, or the addict’s family? Also what happens if these people disagree in terms of their assessment of how much control the individual is indeed exerting over his or her continued drug use?

Also the inclusion of "health and wellbeing and participation in the rights, roles and responsibilities of society":

These are grand terms, but what exactly do they mean? Do they mean that drug treatment services need to be enabling drug users to become good parents, to find work, to be housed, to vote, to understand current political issues, to be happier in themselves, to have better relationships with their families and friends, to not commit crime, to be greener in their lifestyle?

The list is potentially endless of the things that drug treatment services could see themselves doing which are all cumulatively about maximising an individual’s sense of health and wellbeing. But how well placed are drug treatment services to take on these additional challenges when they have found it so difficult to take on the challenge of enabling individuals to recover from their drug dependence?

I might have worded it differently, but this emphasis on recovery as something that is holistic is important. Addiction tends to infiltrate every aspect of the addict's life and it is not always self-correcting once abstinence is achieved. Good treatment and recovery support services must be prepared to address employment, family life, physical health, mental health, community involvement, etc. It is overwhelming, and we don't have to do it all ourselves (Much of it can be achieved through coordination of services--not just passive referrals.) , but the alternative is a system that fails and loses the confidence of addicts, their families, other professional helpers, and the public.When this confidence is lost, the stage is set for criminalization or a system that relies on methadone.