Right to Recovery Bill Consultation response

SASW's response to the Right to Recovery Bill Consultation from the Scottish Government

Right to Recovery Consultation 

The Scottish Association for Social Work is the professional association for frontline social workers in Scotland, supporting, protecting and inspiring social workers in all roles, and the next generations of professionals. It is part of the BASW which is the UK professional body. We develop professional ethics, practice, knowledge, research and learning. We speak out for social work and social workers on social justice, equality, poverty, human rights, oppression and other vital social issues in the UK and internationally to realise our vision that “Social work will be a thriving, influential, respected profession, improving lives and upholding people’s rights across the UK.”  

Question 1.  

The Bill focuses on drugs and alcohol addiction. Do you agree or disagree with the purpose and extent of the Bill? 

Strongly Agree  

Agree  

Neutral  

Disagree  

Strongly Disagree 

 

In relation to Question 1 we have significant concerns. The word ‘addiction’ carries significant stigma (Wakeman, S. E., & Rich, J. D., 2018).  which is a barrier to seeking early help. We believe that headlining the bill in this way is unhelpful and should be either be removed altogether or replaced with ‘substance use’. 

 

Medical treatment and psychological and social support are inseparable in effective interventions in integrated services.  As such they must be tailored to meet the unique needs of everyone. However, the Bill as written presents medical assessment and treatment as the primary intervention over psychological and behavioural interventions.  This is despite the clear evidence base for a range of psychological interventions such as counselling and group work behavioural in supporting people to achieve their goals effectively.   

 

We also have reservations about the current requirement to be abstinent before accessing some medical interventions. We believe that this represents a barrier to early help and for some people may be one that they cannot overcome. 

 

12 step behavioural programmes, in contrast to other interventions, do not have a strong evidence base and the evidence in studies so far suggest that other interventions are equally as effective, if not more so (Bøg, M., Filges, T., Brännström, L., Jørgensen, A. M. K., & Fredrikksson, M. K. 2017) . Unfortunately, the Bill in its current form appears to favour the latter over the former and we would urge the Bill framers to review the evidence.  

 

Effective programmes offer tailored psychological and behavioural interventions which may include abstinence and residential care. However, the evidence for the effectiveness of abstinence programmes is also mixed, and there are significant questions to be asked of the longevity of ‘recovery’ begun in expensive residential care.  

 

We are equally concerned that the Bill is focussed on the individual in recovery without reference to the family and friend system.  Evidence tells us family support is central to psychological stability and abstinence, where that is the choice of the individual. 

Question 2.  

What are the key advantages and/or disadvantages of placing a right to receive treatment, for people with a drug or alcohol addiction, in law? 

With regard to  question 2, as the right to treatment already exists, both in law and in the NHS charter, we can see no benefit to adding another layer of law to existing legislation We believe the focus should be on ensuring that the existing standards are adhered to rather than creating another law. 

Question 3. 

Section 1 of the Bill defines “treatment” as any service or combination of services that may be provided to individuals for or in connection with the prevention, diagnosis or treatment of illness including, but not limited to:  

  • residential rehabilitation,   
  • community-based rehabilitation,   
  • residential detoxification,   
  • community-based detoxification,   
  • stabilisation services,  
  • substitute prescribing services, and   
  • any other treatment the relevant health professional deems appropriate. 

Do you have any comments on the range of treatments listed above? 

There is a presumption in the Bill that abstinence-based services for people who accept the ‘addict’ label and an exclusively medical approach to treating substance use is the most effective way of supporting people. This is a significant flaw in the Bill  which perpetuates an illness model of substance dependency. The research to date confirms that the most effective method of supporting people in dependency is through talking therapies and social supports, including social work, once a person’s consumption has stabilised or ceased.  

 

This Bill appears to prioritise access to services only for people who accept a pejorative and stigmatising label. We do not believe that this represents a genuine choice for the person, is discriminatory and lowers the likelihood of early support and the prevention of deeper dependence on substances. 

 

If this Bill passes it will raise expectations of access to community and home detox, which is not currently available and is not planned for the future. This would take significant additional resource. Please see Social Work Scotland’s comments on the financial memorandum. 

Question 4. 

Section 2 of the Bill sets out the procedure for determining treatment. It states that: 

  • A healthcare professional must explain treatment options and the suitability of each to the patient’s needs; 
  • that the patient is allowed and encouraged to participate as fully as possible in the treatment determination and; 
  • will be provided with information and support. 

The treatment determination is made following a meeting in person between the health professional and the patient and will take into account the patient’s needs to provide the optimum benefit to the patient’s health and wellbeing.  

 

Do you have any comments on the procedure for determining treatment? 

We are concerned about the health orientation of this Bill and the use of 'health professional' and 'patient'. As previously noted, substance use services are integrated making use of the unique specialities of health and social wok staff. Reserving discussions about how a person wishes to resolve what they themselves identify as problematic behaviours to health staff significantly reduces the potential options to support people to live as good a life as they can . We are concerned about the repeated use of the pejorative word ‘addict’ throughout the Bill, and the intimation that in order to access ‘treatment’ a person must adopt that label. We also note, with concern, that there is no recognition of the link between poverty, trauma and addictions such that the Bill seeks to treat symptoms rather than the causes of substance use. 

 

Our members have also told us of their experience of working with eligibility criteria for services in other areas of social work and are concerned that the criteria being explored in this Bill will have a paradoxical effect of only providing support to people who adopt the addict label and whose physical and mental condition is critical. This would prevent allocating resources to early intervention and prevention which is ultimately more cost effective 

Question 5. 

Are there any issues with the timescales for providing treatment, i.e. no later than 3 weeks after the treatment determination is made? 

The Medically Assisted Treatment standards and the 21 day treatment time for Alcohol Drug and Recovery Services is already an effective and workable timescale for the beginning of medical and social support. We do not believe that adding a second, contradictory timescale is beneficial when access to stabilisation and residential rehab places are primarily restricted by funding, not timescales.  

Question 6. 

Is there anything you would amend, add to, or delete from the Bill and what are the reasons for this? 

This Bill is focused on abstinence-based treatment and not recovery, as headlined in the Bill. Harm reduction does not appear in the Bill at all, and we question how connected the Bill would be , if passed, to the actual landscape of services and interventions.  

Question 7.  

Do you have any comments on the estimated costs as set out in the Financial Memorandum? 

We believe that the methodology used to determine the estimated cost is questionable. Our members are aware that a significant amount of support is provided by third sector organisations using a patchwork of funding sources, including a significant amount of non-recurring and year to year funds. 

The Bill suggests a significant expansion of existing resources, but in reality most of the funds identified are already firmly settled in existing organisations. It is difficult to reconcile the ambition suggested by this Bill with the actual funds that would be available to support it. 

Question 8.  

Do you have any other comments to make on the Bill? 

This Bill appears to be driven by ideology that favours abstinence over stabilisation and harm reduction. We believe the Bill represents a step back to the past where a task-oriented treatment regimen was expected to create change in an individual without reference to their wider social and life experiences. Whilst each experience of substance uses and problematic dependency has some commonality with others, the most effective interventions that support people to live a good life are personalised and local. 

This Bill does not recognise the social context and actual costs of all successful rehab and recovery processes, which would be effectively supported by the proposed Executive Agency for social work.