Acorn Recovery Community, Oldham... John Hopkins and Nick Mercer

This week sees our agency being recognised once again for the work we do with alcoholics and addicts in Greater Manchester. On Tuesday we were visited by Baroness Massey, the current Chair of the NTA. I describe the service users as alcoholics and addicts because I want to differentiate from drug or alcohol dependence which is primarily a physical attachment, whereas our service users recognise that their dependence resides primarily in the mind and they invariably identify themselves as addicts. This is an important understanding as the clients’ assessment of their condition is the fundamental building block of their ongoing recovery.

The agency has changed dramatically over the last 4 years and these changes have been difficult. Change, however is what we ask our service users to do every day and we consider ourselves expert in this area. It is ironic however that some of the most skilled professionals who facilitate this process baulk at a cup out of place or a change in the rota. I suppose these recent years have been a salutary lesson to all the staff and have put them in touch with the highs and lows of the change process.

Excitement, fear and anxiety are emotions synonymous with change so, naturally, these feelings have ebbed and flowed within the agency during this time. The staffs’ increasing ability to understand, contain and manage this process of change has been reflected in a dramatic improvement in service user outcomes. The old adage you can’t give it away if you don’t have it springs to mind. I remember vividly the initial resistance to opening up the agency to still-using addicts. It is just four years ago when service users would get no treatment at all unless they were completely abstinent from all alcohol or drugs. I realised then that it was essential that we gave those in active addiction something achievable i.e. hope in the form of an exit strategy. Today we provide 600-700 people with therapy a year and a huge proportion of these become abstinent and enter our primary programme.

The changes in the way we work have developed through looking carefully at what we do and taking an objective perspective of the treatment system as a whole. It became apparent some years ago that agencies such as ourselves could not work alone and if we continued with a policy of passive reliance on other agencies for referrals then we would rightly wither on the vine. The responsibility to get out there and promote recovery became essential to our survival … though one in which we were best placed to act. Again, we found ourselves required to demonstrate something we asked the clients to embrace on a daily basis – the taking of responsibility, a vital part of the recovery process. In 2002 we identified a need for many of our clients leaving custody. They were provided treatment in the day but would return to unsafe environments such as local authority housing or bail hostels in the evening.

The provision of safe secure abstinent housing was provided in the form of Acorn House in 2002. Acorn House has provided a steady state contract via Supporting People to give the most vulnerable the opportunities to reintegrate into mainstream society. The provision of abstinent houses has expanded and has seen partnerships between registered social landlords such as Threshold and Addulham Housing. The increase in provision will see residential treatment beds increase to over 100 by 2009. This provision will be spread over Manchester, Stockport and Oldham.

The changes undertaken have been in response to identified need but they have also been strategic and evidence based. I can remember years ago working for the Probation Service in Manchester and being excited by the “What Works “agenda. I foolishly believed that the powers that be would look at effective practitioners locally and we would all try to emulate their good practice. More recently the monitoring of services has become an integral part of any social care agency. However, the obsession in drug treatment appears to have been with engagement and retention rather than what is actually done.

Over the last two years we have seen around 80% planned discharges from our residential facilities. For the purposes of this article I define a planned discharge as 1 year clean and sober, moving into independent accommodation and in education, training or employment – a formidable achievement by anyone’s criteria. Since 2002 there has never been any case of anyone committing an offence while resident. These outcomes have been one of the main reasons we have moved toward an integrated treatment and housing model. The agency has also developed wrap around services and has trained recovery coaches and mentors to assist in the recovery journey.
Though the model has developed to address local need it is underpinned by the theoretical model described by William White and Ernest Kurtz. The Recovering Community model contains 3 key elements which have become a mantra to many of the staff. The core components of the model are;
• Pre Treatment Engagement
• In Treatment Enhancement
• Post treatment Recovery Support.




The reason we are in business revolves around the quality and effectiveness of our core treatment programme. For many years Acorn has been providing intensive therapy combined with a robust family group. All service users are provided linkage to local recovery support services such as Narcotics Anonymous. Oak House addiction Clinic is part of the Acorn Recovering Communities Project - formerly ADAS, the Alcohol and Drug Abstinence Service. The change of name coincides with the change of philosophy. For over three years the agency has been working with still-using addicts providing pre-treatment engagement in the form of the Reduction and Motivation Programme, RAMP. Acorn sees abstinence as being a part of the recovery journey but not as an end in itself.

The agency delivers the RAMP from various sites in greater Manchester including HMP Manchester Strangeways. The prison programme runs daily and has provided many inmates with insights into their addiction. One of the main aims of the RAMP programme is to encourage entrenched drug users and alcoholics to consider a life without substances and continue their journey into tier 4 services. The prison program has the capacity to provide 360 inmates with treatment a year and estimates almost half of these will enter further therapy at another prison or within the community.

In the community the agency runs the RAMP from primary sites such as community drug and alcohol teams and detox facilities and works in partnership with other agencies such as Lifeline in Manchester.
The agencies expertise however lies in its primary programme which has been running for 11 years since 1997. The primary programme is established and provides quality therapy to many of the most socially dislocated members of the greater Manchester community. The success of the agency has seen rapid expansion recently and the addition of another primary treatment site based in Oldham. The Director of Treatment, Win Parry, was formerly treatment director at the Priory and has over 25 years experience in the field. In addition to the director’s professional experience the 3 treatment managers have over 50 years experience working in the treatment industry and combined with Win Parry provide the agency with a huge repository of skills and knowledge.

The newest and largest of the recent projects is The Oldham Recovery Community. This innovative scheme is managed by a team led by Nick Mercer. Nick has worked in a variety of challenging prison environments where a too rigid adherence to the dictates and time-scales of traditional treatment would have rendered meaningful work impossible. He is at ease with delivering a flexible inclusive model that maximises the effectiveness of the recovery window. I asked him to summarise his views on effective treatment. This is what he said:

“Simply, you have to kindle a spark of hope in those whose predominant mood is often resignation or despair. You have to give them a glimpse of a world that is better than the one they currently inhabit… and you have to convince them of their eligibility for inclusion in that world. You can only do that successfully if you can produce a microcosm of that world in the treatment environment. Therefore, the aim of treatment is to produce a safe and healing environment that makes concrete the concept of recovery as a passage to freedom and a richer life, accessible to all who’ve exhausted the validity of self-medication as a meaningful life choice. It is a place where the inhabitants can begin to taste the fruits of recovery for themselves.

Most counsellors would agree that ‘the therapeutic value of one addict helping another’ is the single most powerful component of primary treatment. It is the immersion in an active peer group imbued with ideas of service and selfless action (the antidote to the narcissism of addiction) – that holds the client in the crucial 1st day of treatment. This is especially important in a day programme where the onus is on the client to return. It is the ultimate manifestation of service user involvement.

I suppose for a perfectly realised vision of a successful continuum of recovery we need look no further than the organic world of 12-step fellowships where total abstinence is simply an aspiration (rather than the essential requirement it has to be in primary treatment) and ‘the desire to stop using or drinking’ is the only requirement for inclusion. If we can successfully replicate the spirit of this philosophy in Oldham then we have the makings of a community of recovery that can have a profound impact on the society in which we live.”