Observer Article sunday 17th November

[saramcgrail]

Worth a read - Long quote from Peter. Funny balance, but strong conclusion

http://www.guardian.co.uk/society/2008/nov/16/drugs-methadone-rehab-heroin-addiction

Sara

[alli]

Really good article, enjoyed reading it and good conclusion, thanks for the link.

[H4U]

Yea in fact mcdermott and i were discussing some of these issues in { All new to me}

[mcdermott]

From these pages, to the pages of the Observer, H4U2C.

The discussions that I have here very much inform my work when I'm talking to the press. Rather than putting my personal view, I try to reflect an organisational view and the Alliance seeks to reflect the views of the totality of users that we speak to, whether maintained or abstinent, 12 step or no step.

I thought Elizabeth did a really good job though. I've just sent her a note to say so. Dave, what did Michelle think?

[H4U]

its reassuring to know, that, the you{mcdermott} being the alliance policy officer as well as press, you actually take the views of members here on this forum, and broadcast it to the wider population.

[dave penn]

I haven't been able to respond to the article until today, on behalf of Michelle, because she has only just read the online edition. Did anyone buy the hard copy version? we were unable to get one as most newsagents around here only get them in to order for specific customers.

  All that aside Michelle felt that on the whole the piece, and conclusion, did go a long way to reinforce the need to understand the complexity of drug dependancy and how individuals need "individualised" programmes to be able to make their own way along the recovery journey.

 There are a couple of things that did stand out though:-
1) Michelle was a lone voice in showing the benefits of MMT
2) The supporters of re-hab and long term abstinence were unable to show any real statistics that showed long term success just anecdotal hearsay and there own moral position that MMT didn't work, that does'nt include the user's who had gone down the re-hab route and been succesfull in their own individual recovery. 
3) I personally haven't got a problem with re-hab and abstinence especially after doing it myself, and it took a lot more than 12 weeks, 2 years to be exact and I wasn't a chaotic user far from it.
4) The analogy of sedating the elderly in nursing home's and doling out Methadone to all "drug addicts" just highlights the problems we are facing in negotiating for appropriate treatment and prescribing any further into the future.
5) On the whole the article ended with a balanced conclusion but I think that the point might be missed by a lot of people because of the perceived need to get people off drugs completely and as quickly as possible and the belief that peoples live's will be so much better when they've got with "the programme"

 It would be great if The Observer was able to do an article that just concentrated on the people who are benefitting, or have benefitted, from long term prescribing but as I have said previously, from my experience, most people who are stable on scripts just want to keep their heads down and leave the past behind them there is too much stigma and mistrust about previous or pesent use to make it worthwhile for most.

Regards
Dave Penn;

[will-c]

I missed the Observer yesterday...dooh.

A point that Dave mentioned above about old peoples home dooling out methadone, in one hand it wont be much different to the medication most of them will be recieving anyway.
the other things thats been playing on my mind is, what happens to people rights once they enter a stage of not being able to make a decision for themselves such as with dementia or strokes. Is their a life will or some sorts to protect people from being detoxed or left without methadone once they lose their choices or do they...

[mcdermott]

I wasn't always so even-handed, H. For a long time, I held some peculiar views that were specific to me. I had that thing that many addicts get, in which they tend to believe that the thing that worked for them, should work for everybody.

And so because I'd never met anyone who actually *wanted* abstinence, I thought that everyone did what I did -- saw treatment as being a subtle code word for 'free drugs on the state'. And  just as a lot of 12 steppers/abstinence centred people have a hard time coming to terms with the fact that methadone maintenance works, I'd never met anyone who had done rehab and found sustainable recovery as a result.

So for the longest time, I used to write these really scathing articles, deriding the treatment system as a scam, the workers as a bunch of lazy whores who'll do or say anythig for money, and argued that treatment was nothing more than a quasi-legal drug distribution system that was necessary in order to stop us burgling houses.

It was meeting a few people who did have experiences of recovery that I believed in and made sense to me. Meeting people who had made the transition from extremely chaotic drug use and self destructive behaviour patterns, to proper, meaningful stability, and listening to them tell me that their lives were genuinely better now -- much better than they'd ever imagined that they could be.

The thing that annoys me most about the drugs field is that so many of us seem so incapable of moving from the narrow confines of our own experience, to listen to those people whose experiences are so widely divergent from our own -- but its not until we start learning how to do that, and do it in a way that genuinely respects other people's experiences of treatment and the stuff that they valued and feel worked for them, that we're ever going to move forward from these stupid partisan polarized positions that people take.

So it's important to me to listen to other people and hear what they have to say. Sometimes, I can come across as somewhat challenging,, because ... well, usually because I feel as though the person is putting forward a claim that doesn't stand up to scrutiny, but that's generally when they're talking about issues of fact, rather than someone expressing a view or describing their experience. But I recognize that, for some people, it's quite hard to seperate out which bits are experience, which bits are empirical fact and which bits are opinion. It's fine that people dont know the finer points of rhetoric though.

That's my job.

[mcdermott]

1) Michelle was a lone voice in showing the benefits of MMT
2) The supporters of re-hab and long term abstinence were unable to show any real statistics that showed long term success just anecdotal hearsay and there own moral position that MMT didn't work, that does'nt include the user's who had gone down the re-hab route and been succesfull in their own individual recovery. 

5) On the whole the article ended with a balanced conclusion but I think that the point might be missed by a lot of people because of the perceived need to get people off drugs completely and as quickly as possible and the belief that peoples live's will be so much better when they've got with "the programme"

I suppose there was me as well as Michelle. She did say, I think, that we were a self-help organisation made up of users, so I thought it was fairly explicit that I was a user too, but she focused on what I had to say rather than on my lifestyle.

I also thought she did a good job of showing the different sides to the argument, though we were underrepresented somewhat. Good conclusion though. In email, you knew that she definitely 'got it'. Hopefully, my interview was supposed to show how the supposed need to get people off ASAP is a dangerous thing that can make people's lives predominantly worse.

Very nice piece in terms of our profile as an organisation though. 

[H4U]

Mcdermott, wow im lost for words here.... i could never have believed that you had in the past, been so skeptical of drug treatment, the thing about how what works for 1 addict should work for another is so not true as you pointed out, ive had family and friends suggest to me to go to rehab, but i personally know that that wont work foe me....i noted what you said in yesterdays article in the guardian that "rehab" can cost 600-1200 pounds a week and multiply that by the 20,000 in treatment....the total sum would be enormous....also the fact that success rates of staying clean are very slim indead, i personally think you have gained so much experience and therefore your opinion on any of these issues are to be highly respected. And as for you coming across as chalenging at times, i see that you ALWAYS have some sort of reliable evidence to back up your points..... I believe people such as myself can learn a lot from you, keep up the good work, like you said its your job! H

[dave penn]

A big apology from me Peter, I really,really didn't mean for my post to exclude your input as someone who is also benefitting from a MMT script but nowhere in the article did it say you were on MMT, but I really don't think that the majority of "Joe Public" would take that kind of phraseology on board about being a user led organisation meaning that staff are actually on long terms scripts.

I started the post with Michelles' feeling about the article and then put in my some of my own feelings.
 I'm sure a lot of people would think that to run and be part of a national organisation we would all be totally abstinent and maybe we all as colleagues and friends actually at times forget that some of us are still on a maintenance script and don't see that changing because, just as in the article's conclusion, recovery is individual and doesn't necessarilly mean total abstinence, so it needs to be viewed in a way that works for the individual.

 For me this is the major downfall of maintenance prescribing, it is nigh on impossible for anyone who is stable and successful to actually be upfront about it. It's not a problem if you work for an organisation like The Alliance and as we have both suffered discrimination in the past because of our 'drug use history' we know it happens but if you don't want to work in the drugs field the barriers must be a lot, lot bigger.

 The article hopefully will have helpled raise our profile in a very positive way and as I hope the rest of the Alliance team are aware this higher profile is only being acheived because of your National and International knowledge, reputation and contact's in the drugs field.

Regards & Respect
Dave Penn;

[mcdermott]

Don't worry, I didn't really feel slighted Dave.

I'm curious about your avatar though. My Polish builder was once showing me his online home -- a website called imperia.pl -- and that's full of photographs of car crashes. As soon as a car crashes in Poland, someone dashes outside, photographs it, and posts it online.

Is your avatar one of those?

[alli]

Yea, McD - I geusse I have sufferred from believing that because I wanted abstinance that most people did - and that their lives would be improved by that - but I am coming to believe now that it is individual, and what works for some does not work for others.  I think I'd been a little bit 'brainwashed' at the NA meetings I had been made to go to when I was in rehab and viewed using any chemical in any form as 'dirty' - (because of their use of the term 'clean').  It was also to do with my own 'stuff' - my internalised 'stigma' about being on methadone and how I felt pressure to come off as quickly as poss. because of that stigma.  I realise now that for a lot of people being on methadone long-term is actually the best option - and they will get the most from their life doing so.  It helped reading the posts here - being involved in service user stuff, and reading the 'black poppy' mag.  My keyworkers at the clinic I attend where actually really good, and after a couple of years of trying to come off methadone - failing miserably each time and ending up in hosp. after using as much as I could get my hands on - told me that they thought it would be best if I just stayed on methadone, and that that might be what was best for me.  It still could be, - I don't know yet, - I am going to give it a go at getting off - I'm down to 4mls and doing pretty well so I'll see what happens.

[dave penn]

This response is from Michelle Kerry;
I thought that the article in the Observer was overall pretty good.For the most part,I feel that Elizabeth Day did a fantastic job and the conclusion of the article was accurate,in as far as that the interview that I had with Elizabeth Day was reported well,but i do think that some important points weren't put forward as forceful  as I made them. Although I did explain that as someone that recieves a long term maintenance methadose prescription,I have continued contact and support from my keyworker and my prescribing doctor with whom I have a great relationship, through honesty and trust .[this wasn't mentioned].I am also able to see them both,with ease,whenever I feel I need this,daily,weekly,or monthly. :PAlso in the article it was mentioned that as well as having lots of different types of support while in and out of resi rehab,that maybe that only happened when a person had been to resi rehab,but this is also very important and needs to be mentioned that this has also been my experience of being on a long term methadose script .Maybe I am one of the lucky people that have a good prescribing service in my local area and all of the workers and doctors there really do give a shit,or it might just be the fact that I have an incredible son and partner who both inspire and support me,always. It is a little of everything that keeps me going on the
long road to where I want to get to.Many thanks to Pete McDermott,
Different strokes for different folks.
Much Love and Happiness to Everyone,Be Good and Safe
Michelle Kerry

[mcdermott]

It was also to do with my own 'stuff' - my internalised 'stigma' about being on methadone and how I felt pressure to come off as quickly as poss. because of that stigma.  I realise now that for a lot of people being on methadone long-term is actually the best option - and they will get the most from their life doing so.  It helped reading the posts here - being involved in service user stuff, and reading the 'black poppy' mag.  My keyworkers at the clinic I attend where actually really good, and after a couple of years of trying to come off methadone - failing miserably each time and ending up in hosp. after using as much as I could get my hands on - told me that they thought it would be best if I just stayed on methadone, and that that might be what was best for me.  It still could be, - I don't know yet, - I am going to give it a go at getting off - I'm down to 4mls and doing pretty well so I'll see what happens.

This stuff is really interesting to me. For a long time, I knew quite a few people like you, and I could never for the life of me figure out what it was they were thinking. They always seemed to be doing detoxes or rehabs, and then coming out again and using as soon as they came out.

And the reason why I couldn't figure it out was, I just wanted the drugs. I had no sense of shame about wanting the drugs. I was fairly functional most of the time and it seemed to me that the bulk of the negative consequences I was experiencing was due to society's reaction to my drug use rather than my drug use per se, so I just felt society was wrong, I was right, and there was no more reason that I shouldn't take opioids than there was that someone else shouldn't drink alcohol. But because I couldn't legally buy opioids, the state had a responsibility to supply me with them, because failure to do so produced many more negative consequences (both for me and for society) than someone who prefers alcohol.

(I still think something like this today, but it's kind of modified somewhat. But that bit is fundamentally unchanged.)

My view changed somewhat in the early 90s. Before that, I'd never seriously tried to quit, and always felt that if I did try, it shouldn't be hard. So in the early 90's, I had a couple of serious shots at it. One as outpatient, one as inpatient. Both failed miserably.

I think that I decided to take a shot because I came to realize that work was more important to me than my script, and my being on a script was getting in the way. Back then, people just wouldn't think of employing you if you were on a script. They'd employ you on a casual basis, for one off jobs that nobody else could do, or that I could do cheaper than other people. But I was getting fucked, basically. So I decided I'd stop my script and take work seriously, and I just couldn't manage it. By that point, I suppose I'd been on a script for nearly twenty years. Started using in '72, first script in '75, and I'd been on pretty continuous since then.

But for the first time, I came to understand what was going on for people like you, alli, who really wanted to be not using, but at the same time, didn't seem able to stop. The realization actually launched me into a fairly long depression, because ... I really hadn't seen my drug use as a problem before that point. The problem was the rest of the world, not me. I was just fine.

And then after my depression, I left the field and set up an IT company. I thought, if the field doesn't want me, it can go fuck itself. I'll go and work for myself on my own terms, and earn far more than I ever did in the drugs field. And it was really just the establishment of the NTA that dragged me back in, when some of the people who were setting that organisation up said 'look, we've got the opportunity to try and fix this stuff and we'd like you to get involved'. That was like, an offer I couldn't refuse.

But I do think that people hugely underestimate the subtle but overwhelming impact that the stigma of drug treatment has.. and the way that it eats away at your self-esteem. One of the reasons why I'm so angry with this whole re-raising of the abstinence issue is that I think it reinforces that stigma, it attempts to paint us as second class citizens who are somehow inferior to people who are abstinent, simply by virtue of the fact that we're on medication.

And part of the problem is that we go down to our clinics and see quite a lot of people who are in methadone treatment who aren't doing quite so well, and are still pretty chaotic, and we assume that the world lumps us in with them. And a big segment of it actually does.

But it's complete bollocks. Our moral worth isn't judged by what chemicals we put into our bodies. Our moral worth is measured by the value of our lives -- by the way we treat ourselves and others. By the way we act, as individuals. By whether we make a net contribution, or whether we just take, take, take.

For people on scripts, society makes it quite hard to value yourself because most people measure their self worth and their identity through their work, and being on a script makes getting work of any sort that much harder. Nevertheless, do you take care of your kids? Do you take care of your families? Are you honourable and generous and open with the people around you? These things, for me, are the things that measure our worth, not the particular chemical composition of our bodies at any particular time, or the state of your consciousness. And all the time, I meet people who are using who are generous, kind and moral, and I meet people who are abstinent who are manipulative, passive-aggressive and self-centred, obsessed with what they can get from others, rather than what they can give.

So I've got no doubts or illusions about what I believe to be the important things, the things that measure our worth as humans, and the drugs that we choose to use really isn't the determining factor.

However, I think that for a lot of people, their drug use can sometimes make it much harder to be the moral person that they'd really like to be. The pharmacology of crack cocaine, for example, mitigates against generosity, and towards self-centred, obsessive, self-destructive behaviour. And similarly, for people who aren't stable on their scripts, it can be a lot harder to be the person that you believe yourself to be because of the volume of time and effort involved in getting well.

And given these factors, I now understand why it is that people have abstinence as a goal, even though they may struggle to achieve it. By and large, those people want a life like everyone else's. Where you don't have to make a superhuman effort to lead the normal life that everyone else takes for granted. Where things like work, and having the financial wherewithal to take care of your family and the people you care about isn't some sort of mirage, but its a part of all our lived experience.

And for all the shit that's in that Green Paper on Welfare Reform, I do think that there's an important core of usefulness. Because by and large, we've got a culture here that has really low expectations of people on a script. We don't expect them to work, and they don't expect to work. The bulk of us get stuck in a long-term poverty trap that only appears to have escape signposted via abstinence. And if you really do struggle to make that, then you can feel as though you're condemned to social and economic exclusion for the rest of your life, and so people aspire to abstinence, often because its the only way that they can see any way back to full citizenship.

But I think our message at the Alliance needs to be that by writing off people who are on scripts, you're writing off a whole lot of people with a great deal to contribute.  But getting us to a place where we feel sufficiently good about ourselves to participate as equal citizens is going to take a job of work for everybody involved in that process. And again, this obsession in certain quarters, with the idea that abstinence is the only outcome worth anything, is really not helpful to anybody other than those in the abstinence industry who are basically chasing resources regardless of the consequence for the treatment population as a whole.