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IN THE SPOTLIGHT: David Best

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David Best
Sheffield Hallam University

Providing hope for addicts and their relatives

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. ‘More than half of addicts manage to kick drugs permanently. We will investigate how they do it and how we can best support them.’

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 four 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.’

Cold turkey

The study will distinguish between five 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.

Peer-based

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.’

Philosophies

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.

Journey to recovery

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?’

Complex

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 one and five years ago, and those who have been clean for more than five 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.’

Focus on success

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.

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