I liked my fellow blogger – Austin McNeil Brown’s reflections on the role of the clinician in recovery:
“Most recovery occurs through social relationships that have nothing to do with clinical technique”
And his observation from lived experience:
“So where did the majority of the momentum for my recovery come from if not through professional channels? Quite simply it came from exposure to the lived experience, values, norms, and beliefs of other who had recovered. In other words, it came from exposure to recovery culture, and the shared sense of identity and meaning that I derived from my association with said culture.”
Jason Schwarz makes the point too about the importance of thinking of recovery maintenance as well as initiation.
Despite this it seems to me that we place a great deal of value on treatment and have not placed the same amount of thought or resource into broader and longer recovery journeys. I’ve heard it said that if recovery is the journey from Edinburgh to London on the train (about 400 miles), then detox is equivalent to calling the taxi and treatment is the taxi ride to the station.
Recovery culture, as Austin references, is embedded in mutual aid groups and my observation is that such groups are often undervalued in treatment settings. The importance of navigating the train journey to London is poorly understood in many treatment settings. There is, however, plenty of evidence of the efficacy of engaging with mutual aid and that evidence base continues to grow.
Audrey Hai and her colleagues undertook a meta-analysis of randomised controlled trials (generally seen to be the highest standard of evidence) on spiritual and religious interventions for substance use problems. They looked at a total of 20 studies which met their criteria involving over three and a half thousand people. In the literature studied, only 12-step approaches were compared with other interventions. These made up 80% of the studies which got into the meta-analysis. Sixty-nine percent of these were about twelve-step facilitation (TSF). Opiate dependence was not particularly well represented, but alcohol and cocaine were.
The bottom line was that such interventions were better than comparison interventions (things like CBT, methadone management, education, relapse prevention). The authors do acknowledge that evidence quality could be better, but that blinding in these sorts of interventions is pretty much impossible allowing bias and confounding to creep in. There were other limitations too representing the challenges of assessing complex interventions.
Having said that, it’s hard to disagree with the authors’ conclusions that they did find evidence of impact and that this has implications for practice. It would be good to see treatment services reporting, as a quality measure, how many of their clients/patients are successfully connected up to mutual aid and other community recovery resources.
That would surely make the journey smoother and the chance of reaching London on the train a lot more likely.