The Birmingham Model — the view from the ground

…by Peter Sheath (lightly edited by Marc)…

Here is a more detailed account of the community-wide treatment approach being implemented in Birmingham. Thanks very much to Peter for stepping up to the plate. Note that this post is a response to the questions and concerns raised by blog members following my last post.

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I’m pretty much overwhelmed by your positive messages and support. It’s taken some time to get to this point. Now we are about to take the quantum leap of helping people begin to deal with addiction problems within their community — as a community. The program has much in common with policies implemented in Portugal, where there have been dramatic reductions in almost everything negative associated with drugs. If it works, and many of us firmly believe it will, it will be a real game changer for the way we approach health care in general. It will help move us away from the “deficits approach” — needing an “expert” for just about every problem we encounter within our societies — to a more co-productive community-based “expert by experience” model, whereby people can take responsibility for resolving their own problems.

Jasmine makes some great points, and we have thought long and hard about almost every one of them. The only one I don’t get is her query, “how the heck could this not create a sense of stigma, othering, and sense of hierarchy?” Much of the model is already happening in a very informal way all across Birmingham.   ethnic  The city is probably the most diverse city in the UK, with lots of communities where English isn’t the first language — communities that just wouldn’t dream of looking for outside help. Part of my role has been to find out what goes on in these communities, how they deal with addiction, and if there’s anything we (ROR) can do to help. Most of the time all I’ve found are very dedicated people doing it for themselves, having developed some astonishing networks involving community elders and local businesses. Far from stigmatizing addiction, these networks have served to normalize it and, in many ways, make it the responsibility of the community.

Note that the start date of our project is March 3, and the leaflet that Jasmine is referring to is intended for interested parties, professionals and commissioners. Once we launch, we intend to consult with service users to develop a pamphlet that’s both user friendly and accurate.

Most of the people we will be working with are already engaged with community resources on a daily basis. Nearly 5000 are in receipt of opiate substitute prescribed medications, which they pick methadone clinicup most days of the week from a community pharmacy, and around another 1000 are accessing the various needle exchanges delivered by community venues. Most people with alcohol problems presently go to either their general practitioner or a community pharmacist as a first point of contact. But most of those professionals have little or no support, supervision and/or training, so they simply refer them on to the alcohol team. That usually causes further delay in getting the necessary help — a problem that could have been resolved at first point of contact.

We have gone to great lengths to ensure that professional help, when needed, is easily accessible and readily available. Clinicians, keyworkers, and structured group activities are never more than a short bus ride away and available within community centres, libraries, etc. The ROR outlets, pharmacies, retail premises, eventually taxi drivers, and many other participants will know exactly where ancommunity workingd at what time help is available. All sorts of on-line/telehealth support will be available as backup. We are hoping that, as the community develops and community champions come forward, professionals can begin to focus on people with complex issues and those who have become dependent on the treatment system for years. Anyway, as you can no doubt imagine, I have work to do, please watch this space for further updates.

Thank you very much, Richard, for your support. I agree with everything you’ve said, and your words resonate with my experience, both as a person who couldn’t deal with life without substances and as a person who has dedicated his life to try to make things better. I believe the answer lies just where it always has, in the community. We, the treatment industry, have in many ways created a monster: we have persuaded people that they are sick and they need professional help to get better. Just as the great Bruce Alexander, Carl Hart and Marc have been saying, addiction is what happens when people try to soothe away things like dislocation, marginalization, poverty, and dissapeople on the streettisfaction. Yet these come about because of the systems or communities people come from. If we create an environment where communities can begin to heal themselves and their members can take responsibility for each other, then maybe change can happen. Up until now, focusing on individuals, isolating them, and treating them as sick has not taken us where we need to go.

11 thoughts on “The Birmingham Model — the view from the ground

  1. Richard February 26, 2015 at 4:11 am #

    Thanks Peter – I would really like to come and visit you guys. I am London based and currently doing my MSc in Addiction Psychology. Am formulating some ideas for a Qualitatuve Proposal for next year – be good to chat / meet ?

    • Peter Sheath February 26, 2015 at 5:22 am #

      Hi Richard and many thanks for the response. I would be great to meet up and I can definitely arrange a visit once we’ve got through implementation. If you want to chat please email me at peter.sheath@emerginghorizons.org
      I will then give you my phone number.

      • Richard February 26, 2015 at 6:14 am #

        Thanks Peter. Will do !

  2. Shaun Shelly February 26, 2015 at 4:30 am #

    Peter, this sounds like a really innovative project and I will be observing closely. It aligns with much of my thinking and I am really encouraged by the continuum of care and the framing of medical issues (such as OST) in medical settings and psychosocial issues in appropriate settings, while using peers to encourage and help develop better relationships. All too often these approaches are presented as conflicting approaches, whereas they are all important.

    In the South African context such an approach would be hugely beneficial. We have a lot of drug use due to systemic issues and access to health and addiction services is difficult and inequitable. To have more community based resources would be extremely valuable and to include a continuum that does not start and end with abstinence as the only acceptable outcome is something I am advocating for strongly.

    I was wondering how you would/are involving law enforcement in this? We have a history of apartheid where law enforcement has always been seen (often justifiably) as the enemy. This status quo is being perpetuated by current drug policy. I am looking looking forward where our police have a more community health policing approach, such as is advocated by LEAP and LEAHN.

    I wish you every success with this project and hope to learn from your experiences.

    • Peter Sheath February 26, 2015 at 6:03 am #

      Thank you Shaun, I know from reading your posts that we are pretty much on the same page. Yes there are some issues with law enforcement but I am finding prisons, law enforcement officers, probation and the courts, more often than not, really supportive and wanting to work with us. In collaboration with them, the organization that I work with (Emerging Horizons) has developed a program called foundations of rehabilitation that is all about desistance from crime.
      I believe that if we can involve people like the police, probation, magistrates, judges and prison officers in delivering some very brief and very simple acceptance and commitment therapy type interventions we could empower them to become involved and give people the help they need exactly when they need it. There’s a very brief animated film on you tube called the tale of the blobs and squares that explains community involvement much better than I can, please check it out

      • Shaun Shelly March 1, 2015 at 2:44 am #

        Thanks! great little video that I shall no-doubt use in the future.

  3. Janet February 26, 2015 at 9:21 am #

    It truly lifts my heart to know that this is happening in our world. And it makes so much sense. Healing from within a community. Human to human.

  4. Richard H. February 26, 2015 at 3:47 pm #

    Peter,

    I remain super excited about the launch of your program. I very much look forward to being updated. Having said that, bear with me while I may seem like I am headed in the wrong direction – or at minimum, being redundant. I’ll tie it all together and share with you my original intent – which is to say thank you.

    There is a process we each must go through – a highly individualized one – to overcome challenges and find our way to a path that works for each of us. In my eyes, addiction is merely one of those many challenges. The fact that the consequences of addiction often take someone to more desperate and high-risk circumstances than those who are confronted by alternative challenges, doesn’t change “the rules’ as much as many believe. The key is for the desire for something better, more meaningful, and in alignment with the individual who struggles to be recognized as possible, attainable. Of course there are a ton more details and steps to prompt individual “recovery”. People need to learn coping skills to keep moving forward, beyond that which triggered their addiction to begin with and tripped them up along the way. However,the premise of desire, hope, and any individual’s inherent ability to create a solid, fulfilling, successful life needs to remain the focus of anyone who sets out to help human suffering. .

    However ironic, the treatment industry has become obsessed with (or addicted to) the disease concept of addiction. Their obsessive emphasis on the pitfalls of the “disease,” somehow manages to only fuel those pitfalls for those who become the recipients of their efforts. My personal experience is that professionals within the industry do not put a shred of effort toward nourishing one’s inherent desire for personal peace and fulfillment. The individual’s “flame” – however seemingly faint, is altogether neglected. It’s all about the “disease”. Consequently, the solution remains under-nourished, while the challenge and its tragic dynamics gets fattened up. The treatment industry, however inadvertently, does more “feeding of the beast”, than anything genuinely helpful.

    My point in re-introducing what’s already been said is to applaud your efforts to implement something that can potentially take over and become successful, where the treatment industry has so tragically failed. I wholeheartedly believe that the entire world needs more of the types of programs you are implementing. It is so refreshing, to say the least, to hear about a program that can actually produce results and relieve suffering. I am a true believer that a “bulls-eye” approach to addiction, in the face of a world filled with misses, will have a ripple effect and at some point in time will start prompting similar perspectives and programs throughout the world. So a heartfelt thank you to you Peter – and of course, to Marc – who may very well become the “ripple” in the effect.

    Richard H

  5. Ron Freilich February 26, 2015 at 4:18 pm #

    I couldn’t agree more on all counts.
    My first thought on constantly hearing about the “disease” of addiction has been the lack of a satisfactory comprehensive definition .. without which I question what it is exactly that’s being “treated”?
    The commonalities of the afflicted are just the tip of the iceberg but unfortunately lend themselves well to I believe a largely ineffective industrial approach.

  6. Erin February 28, 2015 at 1:40 pm #

    This kind of program is an example of building “community recovery capital,” as William (Bill) White refers to it. I often read such different paradigmatic approaches to drug use and addiction, largely in the academic literature, that I truly appreciate it when experts in the field start to converge. Convergence to me suggests that folks might be on to something and maybe that’ll be the start of some change in the U.S.

    I personally don’t think improvements in health care interventions will make much of a difference without addressing the environment, including the community but also family and friends. But, this has to be done in a way that does not encourage isolating people who are addicted, or even just use drugs, as conventional wisdom suggests is the healthy or safe thing to do. I think this – stigma, really – is a fundamental conundrum with which we have to struggle; children and teens are taught to avoid the kids who use drugs, and recreational drug users develop norms to avoid addicted people, addicted people are shunned by everyone, and formerly addicted people are taught to avoid all drug users for fear of relapse. Very few of us are taught that it is desirable to even be around people who use drugs, let alone embrace those who become addicted, to reduce that isolation. Those of us who do not reject them are probably in some sort of ‘helping’ role, which is fraught with all sorts of potential pitfalls around how it shapes one’s identity. Identity is yet another construct around which there seems to be a lot of convergence – except in addiction research, of course, where it is rarely discussed. I’m so glad to see you address it head on, Marc.

    All this is to say that, if we can build into the community multiple points at which someone is not rejected, but instead responded to warmly, it could make a difference – even if the first few times they don’t actually make it to the next step. Perhaps that difference is in bolstering one’s identity as someone who has the option and ability to quit, or someone who others want to be around, etc.

  7. jasmine March 5, 2015 at 6:43 am #

    Dear Peter:

    Thank you so much for your detailed and thoughtful response. I hope I noted that my comments were based on the (limited) information I was able to access. Admittedly, I’m still a bit unclear about some of the more intricate “workings” of the model (i.e. how it would work in certain settings/interactions), it certainly seems like a wonderful and progressive response that can actually help on the ground.

    While I think Erin also made some great points about context, networks, subjectivity (I won’t quote Foucault ;), it seems much of your real work is just beginning. So, I wish you an exciting time of discovery, and applaud your efforts for bringing new light to the proverbial landscape.

    I look forward to learning more, and more…

    Warmly,
    Jasmine

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