If the Scottish Government is genuinely committed to its national mission of preserving lives, it is imperative to thoroughly examine the experiences and lessons from England over the past 13 years. In this field, politics and ideology have exerted excessive influence for an extended period, making cross-country comparisons challenging. However, when the stakes involve human lives, geographical disparities must be set aside, and every opportunity should be seized to learn from the successes transpiring just across the border.

Whilst deaths are also going up in England, when analysing regions with comparable levels of poverty and structural inequality, England has exhibited 3 times fewer fatalities. This disparity can be attributed to two pivotal factors: the prevailing culture within the sector and the professional development of the workforce.

Over time, England has witnessed a transformation in the culture of its workforce. Presently, the workforce possesses a comprehensive understanding and firmly believes in the tangible prospects of permanent recovery from substance use issues. The same cannot be said for the workforce in Scotland. Many who work in the addiction sector/industry have never seen any one recover. Notably, within the United Kingdom’s largest drug treatment charity, which treats three times as many individuals with drug problems as Scotland, at least 40% of the workforce consists of individuals who have successfully undergone their own recovery journey. Although some may argue that this constitutes a decline in professional standards, it is plausible to consider it as an essential reconfiguration tailored to the workforce’s requirements. In effect, individuals with personal experiences of recovery have been recruited, often accepting lower pay, thereby facilitating the exponential growth of prominent charities over the past two decades. Admittedly, this development was partially instigated by austerity policies, compelling the significant charities to devise strategic plans that enabled them to achieve more with fewer resources by employing individuals in recovery.

Moreover, the charities in England have diligently fostered their volunteer base, augmenting their workforce by nearly 30%. While concerns about potential races to the bottom and collusion for price fixing may be legitimate, they warrant separate discussions. In many instances, individuals with lived experiences were just as competent as their predecessors or those currently advancing their professional qualifications. Consequently, England’s workforce now exhibits a more profound comprehension of the field and a higher level of professionalism compared to their counterparts in Scotland. The critical distinguishing factor lies in the fact that recovery has been thoroughly integrated into the fabric of their service culture, workforce, and, most notably, among staff members who lack lived experience.

Critics might contend that the services in England have forsaken their harm reduction ethos and committed staff members. However, such assertions merely amount to powerful and divisive political rhetoric. The notion that the United Kingdom has maintained an abstinence-based recovery-focused treatment system since 2010 is entirely fallacious. While it is not challenging to find politicians or treatment leaders claiming otherwise, the true reflection lies in the funding and implementation on the ground. The narrative of the last 14 years reveals stretched services and funding cuts at a time when drug-related problems were becoming more complex and severe. Within this overarching context, the recovery/abstinence services have experienced the most significant depletion. The majority of the £600 million allocated by taxpayers to the treatment system is still predominantly allocated to Opioid Substitution Therapy and one-to-one case management. Therefore, it is paramount to differentiate between political rhetoric and actual reality.

The aforementioned cultural transformation within the workforce has fostered an enduring cycle of transformation, whereby individuals are profoundly influenced by those who have experienced personal transformation. Such a transformation can only occur when the workforce genuinely believes in and does not take recovery for granted. This level of commitment can only be achieved when a sufficient number of individuals possess firsthand experience with recovery, have witnessed its impact, and possess the knowledge and skills required to support and guide others on their own journey towards recovery. Recovery cannot be simply prescribed; it is better felt than telt, (told) as the saying goes, and no setting captures the contagious and empowering essence of recovery more than a mutual aid meeting. In England, many of these meetings take place within the same premises as treatment services, and most workers adhere to the mutual aid guidance policy, introducing this pathway to new clients who have yet to explore it.

As the renowned management consultant and writer Peter Drucker famously stated, “Culture eats strategy for breakfast.” It is essential to clarify that he did not imply that strategy holds no significance; rather, he emphasised that a powerful and empowering culture provides a more reliable path to organisational success. Consequently, irrespective of the strength of one’s strategic plan, its effectiveness will be hindered if the team members do not share the appropriate culture. Ultimately, it is the individuals implementing the plan who make all the difference. If the workforce wholeheartedly embraces the national mission and vision, they will be enthusiastic about executing the plan, thereby enhancing the prospects of success. Conversely, if the workforce lacks the requisite understanding and skills, the chances of realising the desired outcomes are diminished.

To bring about a culture change within the workforce, England undertook two critical initiatives. Firstly, they strategically employed individuals in recovery at all organisational levels, both operationally and within higher-level systems and structures. Secondly, they introduced operational and strategic guidance that enabled the current workforce to establish a seamless connection between the treatment system and the recovery community encompassing prisons, residential rehabilitation centers, and community services. By doing so, England’s initiatives effectively communicated to the broader sector, particularly the National Health Service (NHS), the exemplary practices that the prominent charities had long been implementing. These practices primarily revolve around bridging the gap between the treatment system and the recovery community. Public Health England’s guidance on mutual aid endorsed the evidence base supporting its efficacy, presenting it as a cost-effective public health intervention that incurs no additional financial burden. Surprisingly, many practitioners found attending their first mutual aid meeting, as suggested in the guidance, to be a revelatory experience.

Regrettably, Scotland’s addiction sector has yet to fully embrace mutual aid, persistently displaying blatant prejudice and stigma at all levels towards this approach. While offering individuals substitute prescriptions does not attract constant retorts of “but it doesn’t work for everyone” or “I don’t believe in it,” a mere mention of the mutual aid path frequently evokes these responses. The classic but profoundly misinformed counterargument, “Yeah, but there’s no evidence base for it,” remains prevalent. If only a pound were received for every occasion such objections were raised, or for every time the prejudiced notion was expressed that mutual aid lacks an evidence base, I would amass considerable wealth.

One of Public Health England’s aspirations is to enhance recovery rates from drug and alcohol dependency. To accomplish this goal, they made a commitment to facilitate effective collaboration between treatment services and relevant community and mutual aid groups, ultimately bolstering service users’ social integration and well-being. Mutual aid encompasses the social, emotional, and informational support provided to, and received from, group members at every stage of recovery from active substance use and addiction. It is not solely a peer support network or a self-help group; rather, it constitutes a fellowship centered around mutual aid. These groups often consist of individuals committed to abstinence, actively endeavoring to modify their behavior through a structured mutual aid program. Additionally, the groups include individuals contemplating cessation or actively attempting to discontinue their drug and alcohol use.

Public Health England has published a collection of documents designed to fortify the connections between treatment services and mutual aid. These resources are listed in Appendix 1. It is particularly remarkable that, during the development of these materials, Public Health England actively sought the input of a national mutual aid reference group. This reference group included representatives from various mutual aid organisations, commissioners, and service providers who collaborated for the collective benefit instead of operating in isolation, conflict, or competition. Scotland need not replicate these lessons independently but rather learn from England’s experiences, including its successes and failures, and adapt them to their unique context.

In conclusion, Scotland can learn valuable lessons from England’s approach to addiction treatment and recovery. By examining the cultural transformation within the workforce and the integration of mutual aid, Scotland has the opportunity to enhance its own services and improve outcomes for individuals with substance abuse issues. It is essential to set aside political and ideological differences in the pursuit of saving lives and prioritise evidence-based strategies that have proven effective in other regions. Embracing a culture of recovery and fostering collaboration between treatment services and mutual aid organisations can lead to positive transformations and better support for individuals on their recovery journey.  

The evidence base for mutual can be found at the link below

The suite of strategic documents developed with Public Health England & (Mutual Aid Reference Group (MARG)  can be found here