Four golden threads — what the voluntary sector brings to treatment and recovery

Since August last year I’ve visited many charities around the country hard at work supporting local (and in a few cases not so local) people struggling with their drug or alcohol use, and, in some cases, their nearest and dearest too.

I’ve been to Brighton in the sun and Leeds in the rain. I’ve witnessed lives in the process of profound change in the town centre of Rotherham and the beautiful countryside of Wiltshire. I’ve chatted with parents in a therapeutic community in Sheffield whilst they cradled their babies, and said the serenity prayer with people in York in the final sessions of a six week ‘day-hab’. In HMP Pentonville I saw how drug treatment is integrated into the everyday life of prison, and how hard negotiating that system can sometimes be. In Exeter I spoke all afternoon to the workers who support the men in the local prison, many of whom have been in there multiple times. In Bristol I heard how the shared-care system locks drug treatment tightly into primary care, sustaining vital care pathways. In Harlow I saw how visible recovery in a residential setting can inspire the people detoxing alongside them. In Hertfordshire I heard how the roasting and brewing of coffee can be just as important a part of recovery as key-working or a medical intervention.

None of this means I have a definitive understanding of exactly what’s happening in every area in England — no person or organisation can boast of that — but it does mean I’ve got a good feel for what these organisations are doing, and can do, for people struggling with some pretty serious life challenges. As you might expect very few people seeking this support were struggling with just their drug and alcohol use. This multiplicity of challenge means that practitioners — as well as being skilled in key working and psycho-social or pharmacological interventions — must be able to navigate the many parallel and interlocking systems that govern our lives. One day knowledge of universal credit it needed to unblock a seemingly frozen benefit payment. The next the focus shifts to getting to know a new worker at the local mental health service to establish a pathway and ease a referral. It’s all in a day’s work.

The impacts of the political shift to localism and the revisions of the Health and Social Care Act of 2012 has left us with a jigsaw of provision with the actors and power-brokers of each areas working in harness to shape an effective response to local need. It’s worth saying of course that the voluntary sector can’t do this on its own. In many areas there is deep partnership with NHS providers particularly around the clinical aspects of opioid substitute therapy, and with other community organisations such as domestic violence services or food-banks.

Having made these trips and reflected on the wisdom of the experts I spoke to — including of course those with a lived expertise in addiction and recovery —  I began to think about the essential characteristics of the voluntary sector in this context. What places us to make a unique contribution to the issue of drug and alcohol use? This distillation process has left me with these four observations.

1. We are driven by values and want to change the world. Many charities were created in response to serious political, health or social injustices. In addition to delivering services to some of the most vulnerable people in our society, many of Collective Voice’s members are vocal at the local or national level on issues they consider morally pressing.
2. Charities arise from the communities they serve — whether defined by geography or shared human experience. This gives them a ‘by us, for us’ feel and makes them natural partners for community level social action and recovery services including mutual aid or peer support structures. It also means charities can gain access to communities, and work with populations of people, for whom more obvious agents of the state would be denied access. This is a very useful attribute when we’re talking about historically highly stigmatised groups of people.
3. We have space to innovate. Our organisational and cultural DNA — as well as our legal status — means we can experiment and take risks in the way we approach things. This thirst for innovation has proved vital, whether contributing to life-saving harm reduction measures in the 1980s or harnessing the power of digital to widen access to brief interventions for alcohol users in 2019.
4. We thrive through partnership. Many voluntary sector providers in the world of substance use (and more widely) have started small, and prospered through successful partnership working. Not being big enough to do everything yourself means collaboration is essential, which (ideally) then encourages the delivery of joined-up services to citizens with joined-up problems.

I believe these four golden threads run through the living tapestry of not just our story as a nation but many of our stories as citizens, family members and human beings. However, being only ten months into my role here at Collective Voice I’m aware there is lots more to discover, in terms of both the varied systems that exist to enable recovery, and the voluntary sector’s unique perspective at the heart of some of those systems. I look forward to writing a sequel to this post next year to consider if these four points need revision, and if a fifth needs to be added. Do leave a comment below if you’d like to make suggestions.