Is there really no substitute for abstinence?

As a drug addict and alcoholic I knew something needed to change, but I was unable to figure out for myself what. I thought I needed to learn how to control my crack use, and better manage my injecting points (my arms, feet and hands were all targets that were now deteriorating very rapidly). Despite this, there was one thing I was sure of – I knew I needed to lose my opiate addiction; that heroin, or whatever substitute I could get my hands on, was killing me – not just physically, but also mentally, emotionally and certainly spiritually.

I’d lost hope of recovering by myself and become resigned to continuing to hurt myself, those around me and anyone that came near to offer assistance. I no longer liked the person I’d become and I no longer tolerated the way I treated people.

So I did what made sense to someone living in a society with a social welfare system – I turned to the health service to help me deal with my ‘health’ problems. And do you know what they did? They prescribed me more drugs. They gave them to me for free. The very same drugs that were killing me in the first place were now prescribed to me. The only difference was I no longer had to pay for them.

Ask a drug addict what they want, and don’t be surprised to hear them answer “more drugs please … and can I get them for free?” Giving free drugs to a drug addict is exactly what an addict needs to maintain their addiction.

Methadone was killing me far quicker than street heroin ever was, and I knew it. I cried out for a detox, but was told that I could only have alternative prescribed opiates in order to manage my addiction. I was told I was not to expect to be provided with the help to actually come off the drug that was killing me because – and this is the reason they gave – too many people had failed in the past!

Imagine the compulsion that accompanies an addiction and then ask yourself just how hard you’re making it for an addict to detox when they know they can access free drugs that will remove the pain and discomfort that’s felt during a detox simply by asking for it.

This was nuts. Not only was this the antisolution to my addiction, it also permitted me to have 24-hour periods without feeling junkie sick, and therefore really focus my energies upon developing a very large crack habit. It permitted me to spend far more time committing crimes to raise cash to purchase crack cocaine, and instead of me spending around £50 a day, I was now committing enough crime to generate over £200 per day, and often double that.

I accessed counselling from various community drug and alcohol teams and always seemed to end up talking with very well meaning counsellors, who did nothing to gain rapport with me, aside from offering me tea and biscuits. They were never able to actually engage me in any meaningful counselling because to me these nice people were simply there to be manipulated; part of the process of accessing more free drugs. They never connected with me because it takes an actual addict to win the hearts and minds of other addicts. Call it some sort of arrogance on the part of the addict, or consider it a place of integrity from the practitioner, but in today’s state-funded services we do see more and more recovering or recovered addicts and alcoholics getting significantly better breakthroughs with struggling addicts and alcoholics.

And so it took just one professional person, a doctor actually, who himself was in recovery, to break through to me and allow me to hear for the first time the solution to my problem. The only way to stop using drugs … is to actually stop using drugs.

It is not rocket science, but simple truths like that are unimaginable or out of intuition’s reach to addicts or alcoholics themselves. When we’re in the madness of our addiction, the only solution we can imagine is one where we’re given more of our poison – and if we don’t have to pay for it, then so much the better. Because drugs and booze do actually work for us. They remove any anxieties and concerns or stress and strain that we may be feeling. They enhance and appear to improve almost any situation.

Boredom and loneliness, two of an addict or alcoholic’s worst situations, are simply and immediately removed when we shove drugs and drink inside us. But when a fellow addict or alcoholic takes the time to talk to me and sees that I’m in a place of hopelessness, they can somehow cut through the nonsense.

So the message is that simple – the only way to stop using drugs, is to stop using drugs.

And that includes the legal ones, the prescribed ones (that are abused for their mood-altering properties); the natural ones that grow out of the ground (that are so seriously genetically modified these days that there’s very little natural about them); the nonaddictive party drugs, and equally important, all of the highly addictive hard drugs.

There is no point in trying to control an addiction. If you could control it then it wouldn’t be an addiction in the first place. And since it’s only ever an addict or an alcoholic who craves re-learning the ability to control their drink or drug use, then surely it’s time to wake up and smell the roses: only an abstinence-based lifestyle has a hope in hell of providing any serious long-term solution.

So what happens when the addict or alcoholic does finally become drug and alcohol free? Well that’s where the real magic occurs; for it is from this place that finally the afflicted person permits their minds to reconnect with reality and to allow their friends and family back into their true lives, revealing their real selves, rather than their deceptive, manipulative, deceitful and destructive incarnations.

Addiction is personified by the following character traits: selfish, self-centred, greedy, controlling, manipulative and destructive, naming just a few. But friends and family of addicts will always tell you that when they were younger they were such nice people. And it is to this that the drug addict or alcoholic, free from substances, can return once they arrive at a place of abstinence.

Don’t we owe that to our fellow citizens?

Don’t we want our society to become a group of people living their lives along more collaborative and spiritual pathways, rather than occupying their own dark and chaotic worlds? Then let’s start by engaging with them properly.

Let’s give our communities a real chance at turning peoples’ lives around so that they become responsible and reasonable members of society once again rather than parking them in their addiction.

Opposition to abstinence is strong, with service users and practitioners alike arguing that it can’t be used as a blanket treatment for all drug users who suffer from complex social problems. One service user recently told me: “You just can’t force someone into treatment … an abstinence-only view of recovery will fail and do much more harm than good.”

The risk of an abstinence-only approach, as noted by our drug practitioners and service users, is that those who are not suited to it will drop out completely and return to chaotic lives. Treatment should be tailored to each service user, but the evidence to date suggests the Coalition Government in England would like to make these decisions uniformly, and unilaterally.

The policy of abstinence-based recovery has now gone beyond mere rhetoric, following the introduction of Payment by Result (PbR) pilots for drug treatment services. The concept seems sensible from the outside; treatment providers only get paid for delivering desirable outcomes and so only interventions that are proven to work will be used. However, the reality is very different and a system that imposes top-down, narrow outcomes is, in our experience, unlikely to succeed. Service users believe that, on the whole, drug practitioners “exercise good judgement” when making decisions about who should be maintained on opiate replacement therapy and who is suitable for opiate withdrawal.

Our service users have complex problems which have root causes that range from mental health, to biochemical, to socio-economic, to tragic life events. It is therefore incredibly difficult, probably impossible, to define a single view of success in this context.

The key fact that any drug policy must take into account is that each drug user has a unique history and comes into treatment with different needs. In order to produce the best outcome for these individuals, the treatment system needs a range of tools. At one end of the continuum it will focus most on stabilisation and harm reduction in its narrow sense. At the other end it should support abstinence, community integration and return to employment.

With fewer funds available for harm reduction, a singular vision for opiate replacement therapy, cutbacks in social housing budgets and an ambition for widespread PbR, the risk is that Government policy is narrowing the boundaries within which drug and alcohol treatment can be delivered at the very time where the evidence suggests they should be broadened. The link between drug policy and evidence remains stubbornly ambiguous.