David Best helped establish the UK's first recovery-focused prison – Holme House – which some are looking to replicate in New Zealand.
When it comes to our prison population, untreated addiction is a significant predictor of whether someone will re-offend, while addiction treatment significantly supports reintegration into society, he says.
"[Otherwise, those people's] only way of meeting their needs is going to be through illicit activities and [their] only escape is going to be through drugs."
David Best Photo: Supplied
The science of treatment and recovery is growing rapidly and involves far more than detox or counselling, Best tells Kim Hill.
"Building up peoples' strength and resources is a more effective mechanism of change than reducing their illness or pathology factors."
Holme House is a pretty typical UK prison, Best says, which has about 750 of its 1,200 adult male inmates on the books of the alcohol & drug team.
The two requirements for a drug-free prison are no prisoners and no staff, he says, so the goal isn't to make Holme House completely free of drugs, he says.
Instead, the aim is to create a new prison culture and structure that gives addicted inmates a better chance of achieving abstinence while they're inside and sustaining it when they get out.
Photo: RNZ / Cole Eastham-Farrelly
Supply prevention is almost impossible as a deterrent, Best says.
The biggest problem drug at Holme House currently is the potent synthetic cannabinoid 'Spice' which is now seeping beyond prison walls to disenfranchised homeless populations and even into the mainstream.
Spice is nicknamed 'bird killer' because it kills time, Best says – 'bird' is UK slang for 'prison'.
"You're basically unconscious and have no idea what's going on for about 24 hours'.
'Spice' is very easy to bring into a prison, he says, and difficult to intercept as it can be soaked into an A4 sheet of paper, then rolled up and smoked.
At Holme House, they use a 'twin track' approach to setting people up to cope post-recovery via:
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new social networks (not associated with drug use and crime)
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meaningful activities (which impart some sense of dignity and pride)
Supportive professionals and supportive peers both play an important role in individual recovery.
"If all your focus is what happens inside the prison, effectively you're building people up only to have the rug pulled away when they get out.
"One thing we know is that if prisons or treatment services are totally punitive people won't make the effort and won't engage in processes to allow themselves to change."
Addiction is not an "equal opportunities employer", Best says, and mental health problems and trauma make people more likely to get trapped in addiction and less likely to get out.
The choices which first lead people into the prison system are made under very strained circumstances to do with trauma, mental health and deprivation, he says.
"People who have higher personal and social capital are much more likely to get away with it to start and much more likely to escape effectively."
Those who experience what is known as 'natural recovery' from addiction are generally people who have personal and social capital, while many who can't seem to recover have no security to return to or never had any to begin with, Best says.
The average length of an "addiction career" is about 27 years from the first use of a psychoactive substance to the point when a person is five years sober (and the likelihood of relapse goes down to 14 percent), he says.
If you see the glass as half-full, addiction recovery is not only possible, it's probable, Best says.
"58 percent of people with substance abuse disorder will eventually achieve five years of sobriety."
Gender plays a role in both the duration of an "addiction career" and recovery, he says.
Women tend to start later and finish earlier, and while this sounds okay will often have more unresolved and untreated trauma to deal with when they come out of recovery.
Women and men also often have different paths to recovery, Best says.
Social networks and peer influence works well for men.
"The single best predictor for men [recovering from addiction] is if you move from a network supportive of drinking or drug-using to a network supportive of recovery."
Yet for women, addiction tends to be less 'social' and frequently related to their partners, he says.
Psychological change and a belief that they can sustain their own recovery journey – with the help of a recovery group – is often key to treating women with addiction, Best says.
"Building up [self-esteem] is what matters most about women attending recovery groups."
Best, whose father was an alcoholic, says alcohol addiction is tricky because – as with gambling – the taxes on it are a big income generator for governments.
Add to that the complicated mixed messages we get about whether alcohol use is acceptable health-wise or even – in the case red wine – beneficial.
"It's a massive oversimplification to say there's a cardio benefit to red wine", Best says.
The general public's view that drinking and even drinking to excess is a good thing has consequences for vulnerable groups with elevated rates of substance dependency and domestic violence, he says.
After years of struggling with ineffective one-to-one addiction treatment, the power of collective treatment have been a game-changer for Best.
"To see the pride, the unity and the transformation of people, it really has been a massive inspiration for me."
He's now heard thousands of addiction recovery stories and says every single one has a turning point inspired by connection.
"The only common characteristic is that nobody does it alone."
David Best was in New Zealand for a conference about the future of Alcohol and Other Drug Treatment Courts.
