THOUGHT FOR THE DAY: 1/5/2011 Is abstinence the best policy for addiction?

Is abstinence the best policy for addiction?

Noreen Oliver, the award-winning advocate of an abstinence-based approach to rehab, tells Mary O'Hara addicts need choice

Noreen Oliver strides into her brightly painted office, smiles broadly and takes a seat opposite a framed collage of newspaper cuttings featuring her outside the rehabilitation centre that she runs. "Sometimes I come in and I look around and I think, 'How did I do all of this?'"

Oliver, 50, has good reason to ask herself the question. When just 31, she had reached such a state of physical decrepitude from alcohol abuse that she was given last rites by a priest, yet, "somehow, I don't know how", she pulled through.

She speaks candidly about her battle with drink. As a teenager in a strict Catholic home, she used alcohol "as a crutch" for her lack of confidence. Her first hospital admission came when she was 25 and she went for nine detoxes in all. "I was a functioning alcoholic. I held down two jobs. But towards the end there were emergency admissions to hospital. I had consultants screaming that I was going through liver failure." She tried to give up but instead pursued a "typical" alcoholic's path of telling herself she "could have one or two drinks, when you can't if you are dependent".

Oliver attributes her recovery – she hasn't had a drink since 1993 – to a number of factors, including a supportive husband (a prison officer she met in rehab) and the fact that her mother and sister found her a place on a 12-step residential rehabilitation programme where abstinence was the treatment of choice.

After almost two decades without alcohol and more than a decade running the BAC (Burton Addiction Centre) O'Connor centres, Oliver has a string of accolades to her name, including an MBE and, most recently, a lifetime achievement award from Iain Duncan Smith's rightwing thinktank, the Centre for Social Justice. This latest award has helped put Oliver's abstinence-based approach to alcohol and drug dependency in the spotlight during an acrimonious time for drug policy.

Debate has long raged as to whether abstinence-only programmes are preferable to harm reduction, including providing drug substitutes such as methadone. It came to a head last week with news that the coalition government is considering stopping the widespread prescription of methadone for heroin users – Labour's favoured policy – and increase the use of "cold turkey" residential programmes. Drug services are also expected to be paid by results if they manage to get addicts off heroin and cocaine. The moves follow proposals to withhold benefits from drug users who refuse treatment. But the UK Drug Policy Commission warned that prejudice toward addicts needs to be challenged if abstinence-based therapy is to work.

Providing choices

As an advocate for abstinence, Oliver might be expected to defend this option to the detriment of others. On the contrary, she refuses to be drawn into a dispute that, she says, is not only divisive, but misses the point. Abstinence is not about telling all addicts that the only way to "move forward" is to stop suddenly, she says – "it's about providing choices".

Any limits on the prescribing of methadone would, she says, be the "antithesis of individualised care" and "may actually put lives at risk". There is no need for a fissure in drugs policy, she argues. The first treatment an addict receives is about "stabilising the chaos", and if that means something other than abstinence, so be it.

When Oliver set up the first BAC O'Connor centre in Burton upon Trent 12 years ago – a second opened in Newcastle-under-Lyme in 2002 – abstinence, she recalls, was a "taboo word". In contrast, she argues that despite the high-profile arguments engulfing policy, there is a burgeoning climate of co-operation among those working in the field, with recovery the word on everybody's lips. She has just founded the Recovery Group UK – made up of academics, rehabilitation service providers and drug- and alcohol-related organisations – to advocate what she calls "a balanced, integrated, seamless treatment system focused on recovery".

BAC opened as a day centre but soon progressed to a residential rehabilitation centre offering therapy and elements such as adult literacy support, and latterly has begun providing short-let flats to help people back into the community. The two centres now treat more than 240 individuals each year and provide therapy for a further 100 family members. There are also 30 recovery champions – ex-service users – working voluntarily across Staffordshire's hospitals, prisons and community drug and alcohol teams, and 80 paid staff, some of who visit police cells and A&E.

At times, Oliver sounds like a cheerleader for the Tories and for David Cameron's "big society". When she talks about Duncan Smith and the CSJ, she sounds almost besotted. "I found him incredible. I don't think I've ever seen a group of politicians engage so openly about [people with a dependency]." She refers frequently to individuals and communities taking more "responsibility" and says people could make more time to contribute to their community if they put their mind to it. But Oliver doesn't let government off the hook. Whitehall departments need to work together more closely, she says, if overlapping problems, such as a criminal record and drug abuse, are to be tackled.

She says a "seamless system" is needed where statutory and voluntary agencies co-operate to get people "off dependency and to an independent life".

People-intensive support

In many ways Oliver defies categorisation. On the one hand she drums home personal "responsibility" as if it's a mantra. She is uncomfortable, for example, with addiction being regarded as a disease because it "makes victims" of people and prevents them from believing they can change "when they can". Yet her approach is rooted in providing ongoing, people-intensive, tailored support for addicts who are unable to help themselves.

As she puts it: "[Drug policy] has been very good at getting people into treatment. We've been very, very good at stabilising them [with methods] such as methadone. What we haven't done and must do is look at what can be done next."

Referring once more to her own struggle to give up drinking, she adds: "The reality is, you can't just put the drink or the drug down. Something has to go with it – people need support as well."

original link is

http://www.guardian.co.uk/society/2010/sep/01/abstinence-drug-rehabiliation-noreen-oliver-bac