Drug policy dissonance: alternative voices of recovery in an abstinence-oriented policy environment

Aileen O'Gorman, Karen Black

Research output: Contribution to conferencePaperpeer-review


Over the past decade, the term ‘recovery’ has crept into the lexicon of drug policy and opiate substitution treatment (OST) bringing with it a divisive debate as to whether abstinence is required for recovery (see McKeganey, 2014; Neale et al., 2013; Wincup, 2016). This study explores the experience and perspectives of people receiving methadone maintenance treatment (MMT) in the abstinence-focussed policy and practice environment of a Recovery-Oriented System of Care (ROSC) in Scotland.

Qualitative semi-structured interviews were conducted with nineteen participants (10 females and 9 males) who were currently engaged in MMT for two years or more and
who self-identified as being in recovery. Interviews were recorded, fully transcribed, coded using NVivo and analysed on a content and thematic basis, with the findings situated within
a policy risk environment framework.

Participants reported ambivalence towards MMT suggesting a level of cognitive dissonance as a result of their contradictory experiences - improvements in health and wellbeing and managing their substance use alongside heightened experiences of stigma from their care providers and abstinent peers’ disapproval of their long-term engagement in MMT.
Ongoing MMT resulted in exclusion from ancillary services such as mental health and trauma support and group talk therapies, and their broader mental health and social needs
remaining unaddressed.

The study illustrates how the lived experience of drug policy dissonance shapes people’s drug treatment experience and outcomes and exacerbates the stigma they experience when not conforming to treatment expectations of abstinence. The study indicates a need for drug policy to avoid privileging abstinence over MMT and award parity to the voices of those with both living and lived experience of substance use in shaping person-centred care. There is a need for drug policy to contextualise recovery more broadly than in terms of substance use and to avoid the assumption that abstinence is a priority or an attainable outcome for all rather it is best seen as one of a number of Harm Reduction outcomes.
Original languageEnglish
Number of pages20
Publication statusPublished - 24 May 2019
EventInternational Society for the Study of Drug Policy - Paris School of Economics, Paris, France
Duration: 22 May 201924 May 2019
Conference number: 13


ConferenceInternational Society for the Study of Drug Policy
Abbreviated titleISSDP
Internet address


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