Harm reduction at the crossroads and the rediscovery of drug user abstinence

'It's not 9 to 5 recovery': the role of a recovery community in producing social bonds that support recovery

AIM

To understand how the social networks of a new recovery community can help sustain recovery, focusing on processes of social identity change, in the context of the wider UK recovery movement.

METHODS

A cross-sectional, mixed-methods social network analysis (SNA) of ego-network sociograms to map network transitions, using retrospective measures. Ten men were recruited from a peer-worker programme, in the South Ayrshire Alcohol and Drug Partnership (ADP), West of Scotland. Network measures were compared between two timepoints, just prior to current recovery and the present time. Measures included size and density, closeness of members, and their positive or negative influence, proportion of alcohol and other drug (AOD) using and recovery peers, and extent of separate subgroups. These were complemented with qualitative interview data.

FINDINGS

There was a significant transition in network composition, with the replacing of AOD-using peers with recovery peers and a broader transformation from relationships being framed as negative to positive. However, there was no significant transition in network structure, with AOD-using and recovery networks both consisting of strong ties and a similar density of connections between people in the networks.

CONCLUSIONS

The transition in network composition between pre-recovery and the present indicates a different set of social influences, while the similarities in network structure indicate that the recovery network replaced the role of the using network in providing close bonds. This helped reduce social isolation experienced in early-recovery and provided a pathway into more structured opportunities for volunteering and employment.

Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: a qualitative study of staff experiences in Norway

Background

Recovery-oriented practice is recommended in services for people with co-occurring mental health and substance use disorders. Understanding practitioners’ perceptions of recovery-oriented services may be a key component of implementing recovery principles in day-to-day practice. This study explores and describes staff experiences with dilemmas in recovery-oriented practice to support people with co-occurring disorders.

Methods

Three focus group interviews were carried out over the course of 2 years with practitioners in a Norwegian community mental health and addictions team that was committed to developing recovery-oriented services. Thematic analysis was applied to yield descriptions of staff experiences with dilemmas in recovery-oriented practice.

Results

Three dilemmas were described: (1) balancing mastery and helplessness, (2) balancing directiveness and a non-judgmental attitude, and (3) balancing total abstinence and the acceptance of substance use.

Conclusions

Innovative approaches to practice development that address the inherent dilemmas in recovery-oriented practice to support people with co-occurring disorders are called for.

Electronic supplementary material

The online version of this article (10.1186/s13033-018-0211-5) contains supplementary material, which is available to authorized users.

Assessing Drug Consumption Behavior With the Heidelberger Drogenbogen (Heidelberg Drug Scales): Reliabilities, Validities, and Cut-Off Criteria

BACKGROUND

The Heidelberger Drogenbogen (HDB) is a German language assessment of substance-specific knowledge and consumption patterns of the illicit psychoactive substances cannabis, MDMA (ecstasy), amphetamines, cocaine, and hallucinogens. The behavior modules for each of these five drugs/drug groups allow for a diagnostic evaluation of the extent of harmful consumption behavior. Each of the five modules represents a single standardized test.

OBJECTIVES

This paper outlines several statistical parameters, Cronbach's alpha, retest reliabilities, as well as numerous validity and cut-off-criteria of the behavioral modules.

METHODS

Participants (N = 4,794) were recruited at schools, universities, in subcultural contexts, and in institutions of substance abuse treatment.

RESULTS

Internal consistencies range from = .68 to .79 while test-retest reliabilities between .87 and .94 were found. The behavior modules of the HDB can discriminate between populations with and without clinical levels of substance use. Furthermore, this measure has incremental validity and higher diagnostic accuracy over competing measures.

CONCLUSIONS

The behavior modules of the HDB are reliable and valid measures of substance use and misuse.

From Crime to Recovery

During the last 5 years, there has been an important shift in the policy discourse around drugs issues. This article reviews the key changes and continuities in British drugs policy since the mid 1990s. It examines the crime reduction focus of the previous Labour government and the processes by which the recovery discourse came to dominate the current policy framework under the coalition government in 2010. The shifts in policy and practice will be explored in relation to how the drugs problem was framed and reframed over time and how shifts within the wider social, political, and economic contexts have impacted these developments. It is argued that although the moves toward a recovery-based policy represent significant changes, there are powerful continuities and remnants of previous policies and structures, which have endured and set the parameters for the current policy framework, particularly in relation to crime reduction priorities.