1. The Drug Treatment Workforce: Ian Wardle January 2013

2. Three different phases of workforce development 2001-2005 HARM REDUCTION Building a workforce quickly 2005-2008 TREATMENT EFFECTIVENESS STRATEGY A focus on psychosocial competence and quality The treatment journey and the role of key-working 2007-2013 AN INSPIRED RECOVERY-ORIENTED WORKFORCE Four key roles in the new recovery workforce Recovery as a bridge between the old world and the new

3. The balance struck by Medications in Recovery A clear and coherent vision and for …maintained by strong clinical leadership OST has legitimate and important place Case management and psychosocial interventions that keyworkers are competent to provide Recovery care plans for those receiving substitution treatments should not differ in any substantial way from those pursuing abstinence-based pathways Audit the balance in your service between overcoming dependence and reducing harm Ensure patients have achieved abstinence from their identified problem drug(s) Assessment to consider recovery capital Build communities of recovery Advocate for mutual aid Utilise peer supporters Ensure recovery is visible P2 Treatment Effectiveness Phase 3 Recovery-oriented

4. Three further questions on recovery: present and future Is Recovery more than an incremental step forward? Is it a paradigm shift? Is Recovery an significant incremental step forward from Treatment Effectiveness? Is Medications in Recovery the end point in our thinking about drug treatment? Or is Recovery a transitional phase: a bridge between the old world and the new?

5. Four key roles in the recovery workforce CLINICIANS Integration and close cooperation Medications in Recovery PRACTITIONERS The new skill requirements NICE; plus the therapeutic alliance Addiction as a social paradigm MANAGERS The key developmental role Key integrations: prevention and treatment; alcohol, drugs and multi-risk behaviours, elites and non-salaried PEER MENTORS AND RECOVERY SUPPORT STAFF In-service professionalism with a community focus Sophisticated local workforce strategies for different segments

6. Is recovery a transitional phase: a bridge between the old world and the new? Is recovery only the first of a series of convulsions and accompanying shifts in perspective and practice? Are we able to describe these changes in a way which enables us to 'think' the key integrations for our sector? Prevention, treatment and recovery. Alcohol and drugs as factors in a multi-risk lifestyle. Shift away from an individualised approach to a social paradigm with a stronger emphasis on social networks and a focus on broader health determinants.

7. Challenging current context DYNAMIC We have not arrived anywhere permanent, or even semi-permanent HYBRID We are neither top-down, or localist FRAGMENTARY Difficult to get an overall view COMBINED 3 ‘current phases: i. Recent Past; ii, Present; iii) imminent future. Each crowds in on, overlaps with and obscures the others UNDER DESCRIBED Transition from present to future is under-described UNEVEN Latest practice developments go beyond ‘best-practice’ guidance of Medications in Recovery.

8. Griffith Edwards the modern age of treatment the modern age of treatment The truth of the matter is the modern age of treatment, although it's got fuzzy edges, the modern age of treatment for drug and alcohol and tobacco problems is probably something like 50 years old. But if I were asked for evidence on efficacy after 50 years, it is still far too slender. Our science is under question, our treatment is under question, our cost efficiency is under question. And I think the challenge today is to do better before time runs out. I don't want people turned away and told they can rot.