Project leader David Best of Sheffield Hallam University hopes that investigating different kinds of recovery pathways in four countries will show that addicts can have a healthy future.
A large ERANID grant for the project 'Recovery pathways and societal responses in the UK, Netherlands and Belgium (REC-Path)' will enable Best to work with researchers in 4 countries (Belgium, the Netherlands, Scotland and England) to identify different successful recovery pathways. ‘In lots of West European countries the focus is on a clinical model’, he says, ‘professional therapy helping people fight their addiction. In the United Kingdom and the United States, on the other hand, self-help is more common. We are going to look at which groups of people benefit most from which types of support.’
The study will distinguish between 5 different pathways. The first is what Best calls ‘natural recovery’. This is when people do it entirely on their own. ‘Just like people sometimes quit smoking,’ he explains. ‘They wake up one morning and decide that’s that. They just stop. Cold turkey. These are usually people who have good resources. They still have a job, friends and a home.’ Though only a small group of people succeed in this way, they do include heroin and cocaine users.
The second pathway consists of a whole range of different professional therapeutic treatments. They will all be part of a single group in this study. Best will also investigate three types of peer-based recovery model, in an attempt to show that so much more can – and must – be done besides the professional, more clinical approach. ‘Lasting recovery requires ongoing support in the community,’ he says. ‘That makes peer-based support so important.’
One of the three peer-based models is the ‘12 steps fellowships’. This is in fact a model based on the Alcoholics Anonymous method. ‘They apply the philosophy that addiction is a lifelong illness. Once an addict, always an addict. The main goal is to try and get control of your addiction.’ The second peer-based model is ‘therapeutic communities’, a form of residential care ideally overseen by fellow addicts in residential communities. They regard addiction not as an illness but more as a symptom of a messed-up life. Housed in country residences, they try to teach addicts and former addicts to live in a new and better way.
The final pathway consists of a mix of all other types of professionally provided services. ‘These are groups that do not work on the basis of a particular philosophy’, says Best, ‘but provide a range of pharmacological and psychological therapies to support and elicit change.’ The big question for Best and his fellow researchers will be which groups of addicts use which recovery model at which stage of their recovery. ‘What does their journey look like? Do they use different pathways? How? When? Who chooses what? And of course: how successful are they?’
The researchers will follow 250 recovering addicts in each country, half of them men and half women. They will also distinguish between people who began their recovery journeys less than a year ago, people who kicked the habit between 1 and 5 years ago, and those who have been clean for more than 5 years. The study will involve former users of all kinds of illicit drugs. And of course they will identify differences between countries, taking account of different policies. As Best himself admits, ‘Yeah, I know, it’s quite a complex research design. That’s why a programme like ERANID is so important. Otherwise we could never undertaken such a complex yet crucial set of research questions.’
Best underlines the fact that the study will focus mainly on successful forms of recovery. ‘Our focus is on success. We assume a 'strength-based recovery model' in which all kinds of professional therapy and peer-based models support each other. Quitting in itself is not enough. It is possible to overcome an addiction but it needs sustaining support from society. Permanent recovery also depends on employment, housing, friendships, quality of life.’ His hope is that the study will give policymakers something they can use to really help addicts and their family and friends.
The European Research Area Network on Illicit Drugs (ERANID) aims to improve cooperation in drug research in order to allow well-founded policy decisions, prevention and harm reduction interventions. Several scientific disciplines and various European countries work together in this network. ZonMw is one of the partners in the cooperation on behalf of the Netherlands and is coordinator of ERANID.