An evaluation of a local authority addiction recovery provision : the impact of change on service users

Abstract

The character and focus of drug and alcohol services has seen major changes in the last decade. The period 2005-8 saw a shift away from dominant harm minimisation approaches to those advocating a recovery focus. By 2011 a drive for abstinence was fundamental to service delivery. The commissioning of drug and alcohol services also changed with the implementation of the Health and Social Care Act in 2012; local authorities now have more powers to determine how health services should be commissioned and re-commissioned to provide „population focused‟ health provision. This research investigated how concepts of recovery were implemented within addictions recovery services in one locality in the North East of England and how the changes to service through regular re-commissioning affected the recovery journeys of those attending the services and the staff delivering recovery provision. Sequential qualitative design was adopted, comprising of a systematic literature review of qualitative evidence of facilitators and barriers to recovery from addiction and semi-structured interviews and thematic analysis of data from service users, service staff, service managers and a service commissioner. Normalisation Process Theory (NPT) was used to frame interviews and interrogate the qualitative data. Multiple factors facilitate or hamper recovery success, including ability to identify with others, creation of a non-addict identity, access to positive peer support and meaningful activities and avoiding the „cliff edge‟ of treatment services. The use of NPT indicates that changes in service delivery, although inevitable, must consider certain criteria (including supportive routines / staff changes / consultation with service users / service location and layout) to prevent detrimental effects on recovery. Recovery is a complex and non-linear process that can be impacted by numerous domains. Maintenance of routine, support of bonds with other service users and staff and encouragement to have ownership of their own future are all aspects important in creating a sustainable recovery.