Recovery Plus your library’s essential reference Feb 2016 13 About the author Dr Joanne Neale BA(Hons), MA, CQSW, DPhil is Reader in Qualitative and Mixed Methods Research based in the National Addiction Centre and working across the Biomedical Research Centre at the Institute of Psychiatry, Psychology & Neuroscience. She is also an Adjunct Professor in the Centre for Social Research in Health at the University of New South Wales, Australia. Jo originally qualified as a social worker and has held positions at the University of Glasgow, the University of York, and more recently Oxford Brookes University, where she was Professor of Public Health. Jo is the senior qualitative editor for Addiction journal; a member of the editorial board of The International Journal of Drug Policy; a trustee of the Society for the Study of Addiction; and a member of the expert committee of Action on Addiction. To optimise treatment and recovery, service providers’ and users’ definitions of addiction recovery must converge more – Dr Joanne Neale and colleagues start the research. Influenced by the medical model of addiction and a pervasive culture of monitoring and performance targets, there has been a tendency to focus on very basic quantitative indicators, weighted particularly towards reduced drug consumption and offending. The extent to which measures of recovery used in the addictions field reflects the goals and aspirations of people who experience problems with drugs and/or alcohol has, meanwhile, received little attention. Patients’ views of their own health and treatment are now proactively sought in many areas of medicine, and this has resulted in the development of myriad questionnaires, rating scales and assessment forms – known as patient reported outcome measures, or PROMs (Dawson, 2009; Epstein, 1990; Garratt, Schmidt, Mackintosh, & Fitzpatrick, 2002). PROMs focus on the quality rather than just the quantity of patients’ lives and give priority to the patient’s – rather than the clinician’s – perspective. We are committed to ensuring that the opinions of those who have experienced drug or alcohol dependence and have been users of addiction services are central to our work. To this end, we are working closely with a newly formed service user research group that is advising us as we progress. We are also using Service users’ views of measuring addiction recovery documenting service users’ reactions to 76 recovery measures suggested by 25 senior service providers – the list is over the page – in a preliminary stage of the research. Measures on which service providers and service users largely agreed will be included in the next stage of the PROM. In this article, we disclose how and why service users disagreed with service providers. This is relevant both to the development of our PROM for addiction recovery, and for drug and alcohol policy, practice and research more generally. The initial exercise revealed that almost all service users agreed that recovery was a very important concept, with only two people from the ex-user group questioning its utility and arguing that it was a meaningless word that had been hijacked by politicians. Furthermore, there was a high level of consensus that recovery constituted a unique personal journey but one that would last a lifetime, as the risk of relapse was ever-present. Service users in all groups emphasised that recovery was not only about their substance taking; rather, it involved them making changes in their lifestyles, behaviours, relationships, physical and mental health, and social circumstances. Whether someone could be in recovery while receiving opioid substitution treatment was a more divisive issue with no consensus in any group. Our analyses found nine main types of problem with service providers’ views of recovery, as below. 1. Expecting the impossible of service users 2. The dangers of progress 3. The hidden benefits of negative outcomes 4. Outcomes that negate the agency in recovery 5. Contradictory measures 6. Failure to recognise individual differences 7. Entrenched vulnerabilities 8. The misattribution of feelings and behaviours 9. Inappropriate language.
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