From the UK Advisory Council on the Misuse of Drugs second report of the recovery committee [emphasis mine]:
…our optimism about recovery should be tempered. Evidence suggests that different groups are more or less likely to achieve recovery outcomes. For some people, with high levels of recovery capital (e.g. good education, secure positive relationships, a job), recovery may be easier. For others, with little recovery capital or dependent on some types of drugs (especially heroin), recovery can be much more difficult and many will not be able to achieve substantial recovery outcomes.
It’s great that people are discussing recovery and looking at outcomes, but I have a few important concerns.
At what point does recovery capital become a proxy for class?
I’m increasingly concerned that recovery capital is becoming a proxy for social class. Whenever I discuss health professional outcomes, the typical response is something like, “Yeah, well, they have a lot more recovery capital than most opiate addicts.” The implication is that health professionals (and people like them) are capable of achieving drug-free full recovery while other opiate addicts are not. This is particularly troubling as maintenance becomes the de facto treatment for opiate addiction and significant financial resources become more important for accessing drug-free treatment of adequate duration and intensity. (Like health professionals get.)
This question brings John Rawls and his “original position” to mind.
In the original position, the parties select principles that will determine the basic structure of the society they will live in. This choice is made from behind a veil of ignorance, which would deprive participants of information about their particular characteristics: his or her ethnicity, social status, gender and, crucially, Conception of the Good (an individual’s idea of how to lead a good life). This forces participants to select principles impartially and rationally.
We have a situation where the experts provide one kind of treatment to their peers and another kind of treatment to the rest of their patients. If these experts had to assume the original position and operate from behind the veil of ignorance–if they were to be reborn an addict of unknown class, race, gender, economic status, etc–what would they want the de facto treatment to be?
If it’s not maintenance, then we have a social justice problem.
Evidence for what?
The other important question concerns the evidence. I have several questions about discussions about evidence.
- How many of these experts view opiate addiction as a hopeless condition?
- Do the experts and evidence address quality of life?
- How many of the experts have an anti 12-step bias or anti-recovery bias?
- How many of the experts receive payments from drug companies or have other financial interests in the drugs they are researching?
- Do the experts recognize the limitations of evidence in making policy?
- Are we getting all of the evidence?
- What influence is PHARMA wielding?
- Evidence for what outcomes?