What’s the relationship between addiction, poverty and self-determination? By AnneMarie Ward
I think most folks can agree in terms of behavioural health that empowerment can be a wonderful thing for those that have the ‘capital’ to claim it. Empowerment means deciding for yourself what your life will be rather than having most of the decisions made for you by others.
Scotland’s dependency to substances is well documented, as are the links between socio-economic circumstances and health, but there is an increasing Scottish evidence base that shows higher levels of dependence, violence and suicide in the west coast of Scotland when compared to areas of the UK with identical socio-economic circumstances. Glasgow has been overtaken in the health stakes by Eastern European cities struggling to shrug off the legacy of communism. It’s being left behind as illustrated in the statistics from Liverpool and Manchester, which show, like-for-like, Glasgow’s citizens are dying younger whatever their wealth. Various theories have been put forward to explain this effect; the weather, Genetics, a cultural death wish?
I’m sure there are many years and grants for research to be made from studying the problem but ultimately it’s the solution that interests me and that solution I believe lies in “Community Health”. This is a relatively new term. We use it to refer to an especially important, but frequently overlooked, dimension of mental health/addiction recovery, an extension of the traditional public health model, a community health perspective.
So it’s easy to think about ill health in terms of epidemic waves; a collision between personal vulnerability and social opportunity if you will. Addiction hits at it hardest with vulnerable people in vulnerable families in vulnerable communities. Heroin & cheap booze and a whole new myriad of “legal highs” (now incidentally forced into the black market where other illegal ‘highs’ are widely available) are anaesthetics to unemployment. In devastated communities, where we find whole generations that are financially better off on benefits and many who do work holding up little hope of ‘getting on’ (up the housing ladder, promotional ladder or even getting beyond just making ends meet), substances of all hue present as a ‘reasonable’ solution.
The infectious nature of addiction/mental health is a subject that has been examined from nearly every angle. However a reverse view is becoming increasingly more clear—healthy and unhealthy behaviour is extremely contagious in our social networks.
Social contagion’, ‘Epidemics’ Individuals, Families, and communities can “catch” Recovery if exposed to it.
I am continually exposed to this power and have great hope that as a nation we can recover. However I think the solution is three fold in nature.
1. Suitable tax powers and a smaller more dynamic state could generate economic activity and get the nation working again, especially in the growing area of green energy renewables. This would generate meaningful work and opportunities for our people.
2. Recovery from addictions is not only possible, it is the reported experience of many people who have (had) addiction problems. Recovery unfolds in the lived, physical community as well as in
the substance misusing communities and it has significant consequences for those wider communities. The growth of ‘recovery capital’ as a collective community concept will involve mutual empowerment; support and recovery contagion in substance misusing groups and it will manifest itself in improved functioning for the family and the wider community. The growth of ‘recovery capital’ within the community, and its impact, should be measured in terms of those lived communities. Recovery capital consists of social, physical, human and cultural capital:
Social capital is defined as the sum of resources that each person has as a result of their relationships, and includes both support from and obligations to groups to which they belong; thus, family membership provides supports but will also entail commitments and obligations to the other family members.
2 Physical capital is defined in terms of tangible assets such as property and money that may increase recovery options (e.g. being able to move away from existing friends/networks or to a¤ord an expensive detox service).
3 Human capital includes skills, positive health, aspirations and hopes, and personal resources that will enable the individual to prosper. Traditionally, high educational attainment and high intelligence have been regarded as key aspects of human capital, and will help with some of the problem solving that is required on a recovery journey.
4 Cultural capital includes the values, beliefs and attitudes that link to social conformity and the ability to fit into dominant social behaviours.
Research, and my own and many others ‘lived experience’, tells us that for those who sustain their recovery, success can be attributed to several key areas. The process of healing ourselves, our families and our communities can make us assets as we start to make amends for the harms we caused and ‘give back’ to our families & communities. Passing on our recovery, ‘ being there’ for those who are still impacted by their damaging dependencies, developing higher levels of ‘recovery capital’, helps us to sustain and maintain our own individual recovery journeys.
Recovery is a “process” of exposure often ‘caught’ through ‘laws of attraction’ from those who have recovered. If exposed enough we can, with work, catch ‘recovery’ from other people in recovery and then pass it on. Families “catch recovery” too and have the potential to spread recovery to others and, if this exposure is optimised, whole communities have the potential to ‘recover’. Of course, many recovered people still carry the stigma and shame off addiction and choose to go about being of service to their families and communities in an anonymous fashion. But, if their community previously saw them as ‘addicted’ their recovery is now visible and contagious. This ‘recovery presence’ this articulation of experience, strength, hope, this evidence of recovery as a reality, has the potential to generate new recovery in all our communities within Scotland.
In Scotland we spend a terrifying estimated 6 billion pounds a year in the addiction treatment arena which often comes under severe criticism for its perceived ‘enabling’ of people around the maintenance of their addictions. Treatments role has to be redefined and clarified. I believe its role is to initiate, introduce and support the hope strength and experience of recovery. The business of ‘sustained recovery’ cannot be achieved in treatment; settings, no matter how compassionate or how knowledgeable the staff are around theories of addiction. While communities cannot prosper through divisiveness and discrimination neither can we as a people recover from our dependence on substances. Rather than waiting to rejoin community life until recovery has been achieved (whether through detox, inpatient care, residential treatment, skills training, etc.) I have found that people are more likely to engage in the work of recovery through the process of establishing or re-establishing their lives within communities. To borrow from the Reverend Dr. Martin Luther King, Jr.’s classic “Letter from Birmingham Jail,” we have found recovery delayed is recovery denied.
3. If the people of Scotland are fully empowered and informed then they can decide for themselves whether they wish to exercise power over their lives and their “country”. Of course, they may decide that they wish much power to remain elsewhere, out of their hands, just as the person with low ‘recovery capital’ might . But I believe we should at least have the opportunity to make this, and related decisions, with our eyes wide open to the possibilities of what’s on offer. In the same way that someone, trapped by addiction or facing psychiatric disability should be free of discrimination, dogma and oppression and enabled to begin their recovery journey so should the Scottish people be enabled and supported in deciding their future.
About the UK Recovery Federation
In all of our work, we are committed to openly and respectfully accompany people, families, organisations, and communities in their journeys of healing and recovery. Our work is best pursued in partnership with individuals and families, local community members, health service providers, researchers and public policy makers.
Recovery and community inclusion occur as a person’s gifts, strengths, and interests are valued and shared. Communities become stronger as they include the resources and talents of all people. Recovery and community inclusion are experienced in the midst of natural relationships in local neighbourhoods, families and friendships.
Our mission is rooted in our commitment to collaboration, flexibility, responsiveness, creativity and person-first approaches.
Recovery refers to the ways that people with psychiatric disabilities or addictions live with their disorders and reclaim their lives in the community. Recovery-oriented care is the assistance that psychiatric and addiction treatment and rehabilitation practitioners provide in support of a person’s recovery.
Social change is like personal change in that it involves the twin challenges of initiating change and then sustaining that change over time. Social change, like personal recovery, requires a maintenance program in order to avoid regression and relapse. It has been interesting to watch recovering people whose own transformation spans years of false starts and regressions get involved in advocacy and become impatient and angry at the slow pace of change in their communities. Conversion experiences are rarer for communities than they are for individuals; social change often involves the same slow stages of change that so often mark the process of personal recovery.