Conversation with Timothy Cook
In this occasional series we record the views and personal experience of people who have specially contributed to the evolution of ideas in the Journal's field of interest. From 1966 to 1974, Timothy Cook was the first director of Rathcoole House and the Alcohol Recovery Project, a pioneering British initiative that aims to help the homeless drinker.
Addiction [A]: Could you just start by giving me a bit of your background up to the time you came into the alcohol field.
Timothy Cook [TC]: I was born in 1938, educated at Loughborough Grammar School and then studied law at Cambridge University. I lectured in law for a year at Sheffield University but then enrolled in a new postgraduate criminology course at the Cambridge Institute of Criminology. It was there that I became very interested in the practical issues concerning the treatment and containment of offenders rather than more theoretical criminology. On completing that course I secured a job as assistant warden at Norman House in north London, a hostel for homeless ex-prisoners. It had been founded by Merfyn Turner, who was a great influence on me. I worked there for 2 years and it was an extremely fast learning curve, very much hands-on work, living in and running the hostel along with the warden and his wife. We worked extremely long hours but I learned a great deal both about myself and about the world of prisons and prison after-care. I then spent 2 years, 1964–66, as a prisoner welfare officer at Blundeston prison in Suffolk. This was a new prison for long-term offenders and was run by a very inspiring governor, Eric Towndrow, another great influence on me. What I soon discovered both at Norman House and Blundeston was the number of men with serious drinking problems going through the prison system.
A: So that was a serious introduction to the world of drinking problems?
TC: I spent many long hours at Norman House dealing with men under the influence of drink with no drinking offences on their record, who when interviewed in prison all protested ‘drink, I can take it or leave it’, which turned out to mean they couldn’t leave it. We had lots of problems with drinking behaviour. At Blundeston it was clear from a close examination of the records that a significant number of men had drinking problems. We started an Alcoholics Anonymous group, which for some men was a remarkably influential piece of intervention. I remained in touch over 20 years or more with several men from the group who never drank again after they left prison. So I found myself becoming increasingly interested in the men with drinking problems and responded to an advertisement for a warden at Rathcoole House, one of those adverts that talked about ‘a challenging and exciting opportunity’, which I now know means only a madman should consider the job! I applied, was successful and moved into Rathcoole in south London on 1 May 1966.
A: Did you have GPs or other doctors involved with the men at Blundeston?
TC: There was a visiting GP but no psychiatric services and certainly nothing in the way of treatment to address alcoholism. Almost all the interventions were like AA. For example, a Gamblers Anonymous was also started. The prison was run on very therapeutic lines and a lot of time was spent talking with individuals, a third of whom at least had serious drinking problems. Many denied this despite their criminal records repeatedly saying ‘when arrested he was drunk’. For a few coming to realize that drink was at the heart of their criminal career was a revelation and a release. As one man said, ‘I became free in prison’. All these men had spent many years in prison with no previous attempt to look at their drinking. Hence the sense of revelation.
A: Was there a moral approach in society in those days to men with drinking problems?
TC: I think the answer to this depends on whether the person with the drinking problem needed help or not. Generally, drinking too much was not regarded as too terrible. We always used to say in my family, ‘every family has a drunken uncle’. Such people were seen as characters, very amusing and everyone shut their eyes to the problems they were causing for others. For the public drinkers such as the drunk on the streets they undoubtedly were seen as the ‘undeserving poor’. They really could do something about their condition if they wanted to. People did wonder why I was spending so much time trying to help the drunks when there were so many other deserving people in difficulties. I think my parents thought that on more than one occasion. For those of us working with the alcoholics there was little point in moralizing, as the men were able to do that quite well for themselves; they were their own harshest critics.
‘We always used to say in my family, “every family has a drunken uncle”. Such people were seen as characters, very amusing and everyone shut their eyes to the problems they were causing for others.’
A: The other thing that was happening at that time was that the disease concept came to the UK in the early 1950s. You mentioned AA and they obviously worked within that idea. Did you think along those lines at all, or were you aware of this influencing how people with drink problems were treated?
TC: Certainly during most of the 1960s the primary model was the disease model. To some extent it helped alcoholics feel less bad about their drinking and was a valuable corrective to the notion of them being undeserving. The model arrived at a valuable time. But then the sociological perspective emerged and passionate arguments developed about whether the disease model was right or appropriate and wasn’t it really the medical profession colonizing another area of human behaviour. But in reality the best psychiatrists had an enormous contribution to make. For me, whatever was being written and talked about the disease model dealing with alcoholics, day in and day out I tended to be much more pragmatic. I didn’t find it helpful to operate from a model mainly because the patterns of the men's drinking and their responses to Rathcoole were so very different. I recall one man who came to Rathcoole and said, ‘I just want to stop drinking. Nobody has ever told me that if I don’t take another drink I will be alright.’ I found him hard to believe but he was right. He went to AA, left the house after a year or so and 30 years later he died from natural causes with I’m told one of the biggest funerals AA has ever seen. He stopped drinking, he worked. It seemed scarcely relevant to agonize about a disease model.
A: What did the men themselves make of the disease model?
TC: In practice many of the men at Rathcoole were not enthusiastic about the disease model. As I said earlier, they were quite hard on themselves—‘it's nobody's fault but mine’. They were angry about the facilities such as the Salvation Army or the Camberwell Reception Centre, with the implication that if better facilities were provided they could straighten themselves out. Their response to the disease model tended to be: ‘of course I’m bloody ill, the stuff I’ve been drinking and sleeping out, who wouldn’t be ill?’. They were as a group curiously resistant to making excuses for themselves, which was how they perceived the disease model. Medical help was provided by an excellent GP, Dr Benno Pollak, and a psychiatric registrar from the Maudsley hospital came on a weekly basis. These services were of a very practical nature and I do not recall that the professional team was ever really exercized by any particular model.
BEYOND THE DICKENSIAN: RATHCOOLE HOUSE ESTABLISHED AS A CENTRE FOR HOMELESS DRINKERS
A: Can we set the context within which Rathcoole was emerging? You mentioned the Salvation Army and the Camberwell Reception Centre. Can you tell us something about how they operated and what their approach was?
TC: Following the establishment of Norman House in the 1950s, which was the first ever prison after-care hostel, a few smaller hostels had developed in London. But the core provision for homeless men and women in the big cities, and in London more than anywhere else, was large lodging houses and government reception centres. Some had dormitories for a hundred people. Dickensian is an overworked term but that describes them, they were in effect warehouses for people. Provision on that scale has now disappeared. The Camberwell Reception Centre was run by the Department of Health and Social Security and was part of a national network of such centres. Camberwell was the largest and took up to 900 people. For homeless people there were few if any alternatives, and many of the men I saw at Rathcoole said they would rather sleep out than use such facilities. For them to go to the reception centre was to have given up.
The lodging houses run by bodies like the Salvation Army were extraordinary places. However humanely they were run, the amount of care and attention that could be given to any individual was minimal. There were no records and no analysis of the people staying in them. They simply kept people off the streets. There were a few inspired staff at Camberwell but they were working in impossible conditions. In contrast, a place like Rathcoole, taking 10 people in a well-furnished house, was a totally different concept. The real practical difficulty was to move people from the street into Rathcoole when they were so resistant to using a large lodging house, even as a holding station until a place became available. Hence, it is not surprising that many men came to us straight from prison or hospital.
A: So Rathcoole was quite an important new development?
TC: Yes. It wasn’t the very first small hostel for homeless ex-offenders, as I have indicated, but it was the first project that specialized in the habitual drunkenness offender. Many had a hundred or more drunkenness convictions. They were crude spirit drinkers, homeless, absolutely the archetypal skid-row alcoholic as the term was then. They were almost universally seen as hopeless, so the idea of a small hostel working in as helpful and as therapeutic a way as possible with this group was certainly a radical development.
A: Who initiated this?
TC: Rathcoole, in my view, was established because of the coming together of a few key individuals at a time when government was interested in trying to tackle the much-neglected problem of prison after-care. Until 1963, the after-care of prisoners was in the hands of voluntary organizations. It was then made the responsibility of the Probation Service, renamed the Probation and After-care Service. It was quickly realized that a key provision had to be the establishment of voluntary after-care hostels. The Home Office established a committee, chaired by Lady Reading, to examine the residential provision for homeless discharged offenders. Griffith Edwards submitted proposals to that committee for tackling the problem of the chronic drunkenness offender, building on his own research at the Alcohol Impact Project (the forerunner of the Addiction Research Unit)—set up in 1964—and the work of the Camberwell Council on Alcoholism—founded in 1962—in both of which he was instrumental. There is no doubt that Lady Reading, a dynamic and powerful figure, was impressed by Griffith Edwards and his ideas. It was not surprising, therefore, that when the Carnegie Trust gave the Home Office Committee funds for a special After-care Trust to promote four new projects, the Edwards proposal for the skid-row alcoholic was chosen as one of the four. The committee reported in 1966 (Home Office 1966). Rathcoole opened on 1 May 1966. It is hard to imagine today that personalities, policies and funds could so perfectly come together to bring about such rapid action in an area of such neglect and unpopularity. It is worth noting that the Prison Service was making its own efforts to tackle the problem. Drunkenness offenders at Pentonville prison were sent to the open prison at Springhill, possibly in the hope that the modest therapeutic effects of open-air and sunshine would be beneficial. But as on release the men were returned to London by bus and deposited in south London, near one of the city's major skid row areas, it became evident that more was needed and that Rathcoole was timely to say the least.
RATHCOOLE HOUSE: OPENING THE DOORS AND THE ISSUES THAT THEN EVOLVED
A: Once you were in post how did things go after that? Did you get a full house?
TC: I had intended to spend quite a lot of time thinking, planning, visiting possible referral agencies and beginning to decide on the ways in which the house would be run. In fact, within a few weeks I was asked to take in a man leaving Springhill on the day before the late May bank holiday. The person referring him was Ken McBride, an inner London probation and after-care officer charged with dealing with the habitual drunkenness offenders in Springhill. McBride was a great supporter of Rathcoole and was destined to become one of the major sources of referral. I agreed to take ‘Manchester Fred’, as he was known. Griffith Edwards advised that my life would never be the same again as the hostel was now open and we should ensure all systems were in place and all policies clear. How right he was. Fortunately, Fred turned out to be a great success but I wonder what might have happened had the very first referral been a total disaster.
A: So what were the practical issues that then emerged?
TC: Within a month the house was full. There were two key issues that emerged immediately. Firstly, should residents be made to get a job? Secondly, if residents drank what should our policy be?
I decided, and the committee agreed with me, that it should not be compulsory to go to work. I vividly remember one man who did not work for the first 6 months and then suddenly one day he got a good job, and never drank again. But during those 6 months when he spent a lot of time in bed the men were hostile to him and confused about our approach. They had quite a strong puritanical streak and argued that all ought to be out at work. One was always wrestling with the impact of one person's behaviour on the others and struggling to achieve a balance. Men needed to stay sober in their own individual ways. Interestingly, getting a job for the men was never difficult so no-one had to be unemployed and the majority were keen to be in work.
A much bigger problem was whether men should be evicted once they began drinking or be allowed back in. Initially we took a tolerant approach. We did not allow them back into the house when drunk and we certainly did not allow them to drink in the house. If they came back drunk I would probably take them to the Camberwell Reception Centre or tell them to go away and return in the morning when they would be re-admitted. Some of course disappeared forever. This ‘policy’ led to considerable confusion as to our purpose. If we really wanted to help them to stay off the drink (and for them one drink was the killer), then our approach was, to say the least, a mixed message. It all really came to a head at the very first Christmas in 1966. We had a full house. All the men were in work but by Christmas day there was not a single man left in the house. All were drinking. Some returned and we took them back. Some I went out to find and invited them back. But then we realized this was a very chaotic way to proceed. We decided that we had to engage the residents much more in developing an appropriate policy. This was the key development in the history of the house in my time.
As a whole group we decided that the policy should be ‘if you drink you are out’ and there was to be no immediate re-admission. It was clear that the effort to stay sober was colossal enough without the confusion of thinking ‘well, if I drink for a couple of nights they will have me back’. So within the first year we had developed a policy that if you drank you left. For some of the referring agencies and other facilities that took a different view, such as St. Mungo's and the Simon Community, we were viewed as highly punitive. They argued that if you are dealing with alcoholics you must expect them to drink. This seemed to beg the question as to whether they could be helped to stop drinking altogether and rather assumed they could not, even perhaps we should not try to stop them drinking—this was the liberal 1960s. But we only had 10 places and we knew there were other facilities where men could stay and go on benders from time to time. We were not short of referrals. The new policy reinforced the men's own commitment. They wanted to be somewhere where people did not return having been drinking. Either the house was different or it wasn’t. We tried on this, as on many other issues, to be different. The Christmas of 1966 was a total disaster. We rebuilt and learned from that and certainly there was never a disaster on that scale again.
RATHCOOLE: WHAT WAS ITS TREATMENT APPROACH?
A: So, they went out to work and were expected to be alcohol-free. What else did the treatment approach—if you can call it that—consist of?
TC: This was always the most difficult question that visitors put to me. Partly because Griffith had great faith in us and partly because we were tackling such a neglected problem, there were often visitors: from the Home Office, the probation service and some from the USA. The Americans always asked immediately just what was the treatment programme. I always felt acutely embarrassed because I could not, hand on heart, talk about a treatment programme, as I assumed the term was understood. Although I have to say when I actually read accounts of American Skid Row projects I was not at all sure that they had clear programmes either. The core of what we were trying to do was to engage the men as much as possible in the responsibilities of the house. This began in quite small ways but gradually expanded during the initial years.
A: House meetings?
TC: There was a weekly house meeting, which the psychiatrist attended but which was in no way a treatment group; it was often much more to do with the practical issues in the house. But even very practical matters such as organizing the cleaning could produce some challenging discussion. The men were resistant to responsibilities for the cleaning and evaded them by saying ‘someone will clean the stairs’. The ‘someone’ was ubiquitous. At one such discussion I recall Tommy saying ‘how much rent did “someone” pay and which room was he sleeping in?’, so forcing the group as a whole to take real responsibilities. Attempts to prompt discussions about motivations to stay sober or what sobriety might consist of were less frequent and I am not sure what impact they had on the residents. Discussions about why they drank were always very matter-of-fact. It never seemed an area that really interested them, certainly not in a group setting. For almost all of them the drinking had begun 25–30 years ago, so was rather lost in the mists of time. A not uncommon response when asked why they drank was, ‘well, we all just did where I came from’.
A: The house seems to have worked on cultivation of self-responsibility?
TC: We certainly tried to develop the theme of responsibility as far as possible. I referred earlier to the whole house being involved in deciding on the policy of ‘if you drink you are out’. As I described, such an approach may not seem particularly taxing yet I remember vividly one resident who said plaintively, ‘I came here to get sober not for all this responsibility’. He actually turned out to be one of our great successes! Then I was married in 1967 and went to live in the second house, which was just being opened, so we took the opportunity to gradually phase out residential staff at Rathcoole, having begun with two, me and a community service volunteer. Within 2 years there were no residential staff at all. As we developed this, one committee member said, ‘they will burn the house down’. All one could say in response was, ‘I don’t think they will’. They certainly did not and we were all eventually convinced that in fact there were fewer problems with drinking than previously.
‘Within 2 years there were no residential staff at all. As we developed this, one committee member said, “they will burn the house down”. All one could say in response was, “I don’t think they will”.’
We then took this a stage further by having all prospective residents interviewed by the house as a group and the admission being determined by that meeting. In reality, very few were ever rejected but it was extremely interesting to hear the exchanges; the questions asked were every bit as perceptive as any I had asked in the early days. This eventually led to a resident being elected onto the management committee.
A: What was the GP's role?
TC: This engagement in responsibility was backed up by the men being given a great deal of personal attention and nowhere was this better demonstrated than by the support and interest of the GP, Dr Benno Pollak. On admission to the house Dr Pollak gave each man over an hour's medical examination with blood tests and all the works. There was also an interview and assessment by the psychiatrist. The men always spoke very highly of these procedures and in particular of the medical support of the GP. In practice, very few serious medical or psychiatric problems ever emerged. Dr Pollak was always astonished at how basically healthy the men were and how very matter-of-fact they were about disasters that had been befallen them: one had no idea where or how or when he had lost an eye.
But behind all this lay employment. Despite a lifetime of drinking many of them were very keen to get into work and saw that as the backbone of their recovery. Their enthusiasm for work could always take me by surprise. One man was admitted one evening and left the house very early the next morning and by late evening had not returned. I assumed he had gone drinking. But he returned having already started work—he even had had the choice of two jobs!
A: Looking back, do you think that more intensive treatment might have been helpful?
TC: Whether a more intensive and focused treatment programme would have been more effective is difficult to judge. Certainly, much later on in the history of the project there were much clearer attempts to introduce specific therapeutic programmes. Over the years, I have met many of the men who came through the houses in those early years and asked them what worked or what was the reason for them staying sober. Without exception, they all come up with something rather idiosyncratic and certainly never came up with a main cause. What they don’t ever say is things like ‘it was the insight you gave us into our drinking’. It would be extremely difficult to construct a programme on the basis of what I learned from those who were successful in those early years. Given the nature of the men and their drinking histories, I suspect that the services provided—which were light years away from anything else available at the time—were appropriate and apposite.
A: But in other places were they getting counselling?
TC: Not to my knowledge. There was certainly no reference to it in any of the literature I read. In the few hostels there were for homeless people, including alcoholics, no-one ever really talked about counselling in the way the term is now understood. There was advice, support, argument and discussion far into the night with individuals, but that would not be recognized by anyone as counselling. As far as the homeless alcoholic was concerned, much of the work focused on how to get them to the facility in the first place and what to do when they were sober. As one resident famously said to the psychiatrist, ‘I have been sober 6 months, worked, saved money and bought a bicycle, what do I do now?’. Trying to cope with a sober life and more independent living was a huge challenge for them, and that was why AA was so powerful for some of them. I went to a lot of open AA meetings and they were highly instructive, and entertaining. It was certainly an excellent way of spending one's evenings. I was always surprised that very few of the men ever went to the cinema or a football match. So there was a huge challenge around life as a sober being. It is exactly the same challenge currently facing the government's Rough Sleepers Initiative, when every effort is being made to move hardened rough sleepers into settled accommodation. The problem is the boredom. It is quite clear that the excitement of the first steps in most kinds of rehabilitation is almost palpable, but then comes the huge ‘what next?’ question. I am not sure that the answers to that can be boxed into neat programmes. But, again, I have to say that my experience was with a very specific group of men and approaches I am sure were and are very different, say, for women or young people.
EXPANDING THE FACILITIES
A: You said you moved to another hostel?
TC: After Rathcoole had been running a year it was clear that some men were doing extremely well. We had two who had been there virtually the whole year. When I married in March 1967 it was not possible to live in my one room/office. At that time the committee was wanting to buy a second house. They bought a house near Clapham Common and Margaret and I had a flat at the top of it. The men who had done well at Rathcoole moved into it. About a year later we bought another house with independent bedsits not far away. So within 3 years we had two hostels and a group of independent flats but exactly the same number of staff that began in 1966. All these facilities are still operational, and of course many more.
A: It grew quickly in a sort of progression?
TC: In terms of the houses it certainly did. Then in 1968 we began to discuss whether we could do more in the way of outreach to the men on Skid Row and how we could support men who wanted to get sober but were still drinking. We were conscious that men could be referred to the house as much by luck as design and that we needed to have a point of access that was close to where the men were drinking. We developed the notion of the ‘shop front’, a concept and service that is now part and parcel of the provision.
‘We developed the notion of the “shop front”, a concept and service that is now part and parcel of the provision.’
To develop this facility we obtained a very generous grant from the City Parochial Foundation (where, incidentally, I ended my working career), which was sufficient to open up three shop fronts and appoint a research worker. The shop fronts opened in 1970 and from then on we were called the Alcoholics Recovery Project (ARP), later the Alcohol Recovery Project. This work was really pioneering and was a positive and constructive facility. They were open 2–3 hours a day and were staffed by one worker, usually helped by an assistant who was a recovered alcoholic. They would talk with the men to see what they wanted, refer them to hospitals and keep them on the waiting list of one of the houses. It also developed into a very valuable facility for men who had left the houses because of their drinking but who could then be supported and eventually admitted back into a house without being lost totally to the streets.
Shop fronts are still very much part of the core services of the ARP and offer a very wide range of help. There is counselling, groups, real treatment programmes as well as just a drop-in. Some have women-only days and one is for black drinkers. The experimental nature of those early days continues, so that for example in one shop front acupuncture is offered as a treatment. I visited one of the shop fronts last year in Camberwell, a facility vastly superior physically to those early days but still retaining the same ethos of outreach and a manifestly positive response to a wide range of people with drinking problems.
A: So over the first few years you achieved remarkable expansion?
TC: Almost 4 years to the day after I moved into Rathcoole House we had three residential houses, three shop fronts, a research worker and a small office. We were well supported financially by government and charitable trusts. Progress indeed. Incidentally, when I went to work at the City Parochial Foundation in 1985 I was quite surprised to see from its records, carefully minuted since it began in 1891, that the ARP grant in 1968 was the first ever made to a voluntary organization dealing with alcohol problems. In the previous 80 years there had simply not been voluntary bodies engaging with alcoholics in the way that was to become so much a feature of the 1960s and beyond. Of course, there were missionary societies, the Salvation Army and the like, but this was a different order of things from charities like the ARP. The 1960s marked a turning point of constructive charitable endeavour as far as many groups in society were concerned, not least the homeless alcoholic.
MAKING THE RESEARCH CONNECTIONS
A: Can we go back a little and talk about the research. You mentioned that there was a research worker attached to the ARP. There was some research done at Rathcoole as well, is that right?
TC: There were two aspects to the research, namely the research we did ourselves and that done by others. There was a detailed analysis by Jim Orford and Shirley Otto, two psychologists at the Addiction Research Unit, of a number of alcoholic hostels including Rathcoole. This led to a book, Not Quite Like Home (Otto & Orford 1978). We wrote a paper for the BMJ and Dr Pollak and I wrote various papers for other journals (Cook, Morgan & Pollak 1968). We had a passionate interest in writing about the work, and the close links with the Addiction Research Unit certainly encouraged that. I have always believed that the voluntary sector is poor at writing about its work so that a lot of important experience is lost as a result. So I tried to keep good records and ensured that we had material for appropriate articles and even the occasional book.
With the funding from the City Parochial Foundation we appointed Peter Archard as a research worker, who decided to undertake a major participant observation study with the drinking school on Camberwell Green. He was at the same time part of the ARP team and fed his insights into us just as we questioned his interpretation of the men's drinking behaviour. It was an extremely valuable partnership. He wrote two books from this study, a popular one for the ARP, The Bottle Won’t Leave You (Archard 1975), and a more academic work that was essentially the publication of his PhD (Archard 1979).
A: People talk a lot now about research having an impact on policy and practice. Were you aware at the time of any sort of effects of the research on policy or practice?
TC: I think it is very hard to establish clear causal links between research and eventual policies and practice, especially in the social welfare field. Research certainly helped move us away from relying on the anecdote and created a climate in which we were able to talk seriously and knowledgeably about this particular group. Archard's research provided a valuable angle on the users’ perspective, which had previously been missing. The overall success of the early years at Rathcoole helped push the Home Office into establishing the habitual drunken offenders working party, which began meeting in June 1967 and reported in 1971 (Home Office 1971). This climate had been helped by a 3 day international symposium in 1968 on the drunkenness offence—hard to believe now that so many people gave so much time to such an obscure area—but that says something about the excitement of the times (Cook, Gath & Hensman 1969). We had lots of discussions with the civil servants responsible for drafting the famous DHSS circular 21/73, Community Services for Alcoholics (Department of Health and Social Security 1973). So in one way or another there was a sense in which all that we did, including the research, fed into the policy arena.
As far as research affecting practice was concerned we discussed research material a great deal, particularly that from America. Research that Jim Orford did on motivation was challenging and helped to correct what were otherwise somewhat simplistic views. So it is fair to say that there was a constant interaction between the researchers and the practitioners. An interesting example was one of the first shop front workers, Joan Walley (now an MP), who went to America to look at their experience of detoxification centres, which were being strongly advocated at that time in this country. She reported back at length and we began to see that there were huge problems about such centres. It was not at all as straightforward as the proponents were arguing. There was a real danger that such centres simply created another ‘revolving door’ rather than being a major step in the treatment ladder. All the time we really engaged in practitioner-led research but had a strong respect for the research being carried out at places like the Addiction Research Unit, and worked hard to create a constructive relationship between, as it were, the ivory tower and the grass roots. Too often there is a damaging divorce between the two.
THE HABITUAL DRUNKENNESS OFFENDING WORKING PARTY
A: Can you tell me about the habitual drunken offenders working party?
TC: Everyone who had been involved in setting up Rathcoole knew that even if it was 100% successful it was still only a drop in the ocean, and that a much more strategic approach needed to be developed to tackle this problem. Lady Reading undoubtedly took that view and with the evidence emanating from the Addiction Research Unit as well as the first practical demonstration of what might be done from Rathcoole, there was a strong argument for looking at this problem much more widely. I recall a supper meeting at Lady Reading's house with a few of us and the then Home Secretary, James Callaghan, and—behold—the working party was established. That is how it seemed anyway.
The eventual report was remarkably thorough and humane and owed much to the chairman, Terry Weiler. Its recommendations could certainly be revisited today as too many remain unacted upon. But looking back now I wonder if we ever really resolved the tension between a group of people branded as offenders and hence in the prison system but who had a health problem, namely alcoholism. The Home Office wanted to help them, even to the extent of considering, for example, how the prison physical education instructor could help them! There was a resistance to saying these men should not be in prison at all. The Home Office was defensive and could not admit it really did little for this group. At the same time the Department of Health and Social Security, which was only just beginning to think about its responsibilities in the alcoholism field, was understandably not too enthusiastic at seeing itself responsible for this difficult group. It was interesting, however, that when Sir Keith Joseph became Secretary of State at the Department of Health there was suddenly much more interest in the area. Funds were made available to help alcoholics and circular 21/73 was issued (DHSS 1973). The department then set up its own advisory committee on alcoholism. What really lay behind all those sudden developments in those few years was hard to understand at the time and is not that much clearer now.
A: So you left the alcohol field in 1974?
TC: Yes. I left to do an MA in social policy and public administration at Brunel University. I had spent nearly 9 years in a very exciting but highly specialized field and I needed to broaden my horizons. The course certainly did that. I had intended to return to the ARP but quickly realized I no longer had the energy for that kind of work. While on the course the book I had written about the ARP, Vagrant Alcoholics (Cook 1975), was published. That was really my signing off point.
A: Things were changing by 1974, with ideas about the alcohol problem being related to the total alcohol consumption of the population. Did that have an impact?
TC: At the macro level the consumption debate was certainly beginning as well as a serious discussion about controlled drinking. There was a growing awareness also that women had been neglected in the treatment services. But the world in which I worked, as I said a specialized world, it was all still about the homeless skid row crude-spirit-drinking male alcoholics. Very few people would recognize this group today. Crude spirits have largely gone. Mixed substance abuse is common. Younger people are homeless and drinking on the streets. I saw very few people under 40 never mind under 30. Debates about consumption and the wider alcoholism strategies were interesting and I participated in them but they had little impact upon the work of the ARP. We were involved to some extent in the broader alcoholism issues through events like the British Summer School on Alcoholism, which began in 1970. I suppose one of the reasons I went to Brunel was that the demands of a hostel-based environment was such that it gave one insufficient time to consider the broader issues of alcoholism, never mind social policy more generally.
One feature that was still strong at the time and relates in a way to this matter of trying to connect with the larger field was the interaction between the work of the ARP and researchers and their joint engagement with the policy makers. I think this has largely been lost. The larger an organization becomes the greater the funding pressures there are, not to mention the problem of simply managing the enterprises. It leaves insufficient time for the wider activities that were much more easy to engage in when it was simply a hostel or two. Some large organizations overcome this but too few. Star ratings for hospitals and research institutes add pressure on that side of the equation. I just wonder whether today the number of young psychiatrists who were instrumental in supporting and developing the ARP can give their time in a way that was possible 30 years ago. I’m sure that such community involvement is not part of what is measured when stars are being awarded.
In my work at the City Parochial Foundation I considered thousands of applications over a 13 year period, not just in the addiction field of course, but rarely did applications build on a piece of research, feed into research or build on research findings. In so many areas the gap between practitioners and research is huge—and much more bridge-building needs to be done, with funders in government and elsewhere playing their part.
A: From what you say it is obvious the field has grown and there have been improvements but you have a sense of loss as well?
TC: Yes I do have a sense of loss but am aware I have to guard against the effects of age and rose-coloured spectacles. I was part of an exciting, rewarding and deeply fulfilling venture. Much was achieved and anything seemed possible. Fortunately, during my time at the foundation I saw many people equally enthusiastic about their current role in the voluntary sector. But what I think is much more difficult is getting new ideas implemented. When I re-read the application we made in 1968 to establish three shop fronts and appoint a research worker I doubt if a similar application today would succeed. The requirements of funders have become demanding and daunting, with an emphasis on business plans, outputs and outcomes that seem to me to run counter to true experimentation. If we had been asked to make forecasts about the shop fronts the only honest answer would have been ‘we have no idea whether they will work or what will happen’. Funders need to be more accepting of such responses, particularly if highly intractable problems that by definition do not allow for neat answers are to be tackled.
‘I was part of an exciting, rewarding and deeply fulfilling venture. Much was achieved and anything seemed possible.’
A: By the time you were leaving in 1974 the Kessel committee (DHSS Advisory Committee on Alcoholism 1978) was starting, of which you were a member. What are your memories of that?
TC: My detailed memories are indistinct. But I have two strong abiding impressions. First is that the committee was quite often gripped by strong arguments between the different medical members, among whom there were some different perspectives, each equally passionately held. The second was that it really did not see itself sufficiently as a committee geared to take action or to see that action took place. I had resisted becoming a member of it because of that fear and to some extent it turned out to be justified. It was essentially a lost opportunity, which is not denying the limited contribution it did make. Government is today still trying to develop a national alcohol strategy, which in fact could have been laid down by the Kessel committee.
A: What did you do after 1974? Apart from the Kessel committee, did you retain any interest in the alcohol field?
TC: I have always remained interested in the field but not contributed in any significant way. I have certainly avoided going on any committees of voluntary organizations working with people with drinking problems. It is harder than one thinks to avoid looking back to what used to happen ‘in my day’. Even the term alcoholic isn’t used any more so I feel very dated. After the Brunel course I went to Cambridge House, a settlement in Camberwell concerned with community development in the area and from there I went in 1978 to be the director of Family Service Units, a national organization concerned with disadvantaged families and communities. In 1985 I went to my last job, as Clerk of the City Parochial Foundation, established in 1891 to benefit the poor of London.
A CONTINUED INTEREST IN THE FIELD
A: Are you still interested in the ARP?
TC: The interest in the ARP persists and I continue to learn things about people with drinking problems and their recovery. I recently played a small part in the ARP celebration of its 35th anniversary, noting with astonishment that it now has an income of over £4m. It was quite exciting to go back and to see that ethos with which we began has persisted. It has always been my experience that the initial culture of an organization continues to shape it. There is every evidence from the ARP's anniversary that this is true in its case. The questioning, challenging nature of the organization persists and it remains an exciting place to work. The user's perspective is powerful and plays an important part in the organization's development. All this was heartening.
Above all, the ARP remains committed to the homeless drinker although it has broadened its range of services to help people who are not on the streets. The broader remit makes sense in today's climate. Too many organizations move ‘up market’ to improve outcomes and hence funding opportunities. At the foundation we were aware of the danger of services set up to help ‘the poor’ actually ending up assisting the ‘not so poor’. The drive for proven results should not lead to services avoiding the ‘hard end’. The ARP has not gone down that route.
A: You mentioned that the street drinkers of today are a different population from 30 or 40 years ago.
TC: In parts of London I still see the old-style drinkers and in the same places. But at the same time there are younger men and women. We were once referred a 22-year-old whom the men rejected on the grounds that he could not be an alcoholic, and in any event it would be bad for him to be with the group of 40-year-old hardened drinkers. Women did not feature. There was a reception centre for women and gradually organizations were established to help women with drinking problems. Ethnic minorities were not part of the scene at all. We only took in one black person in my time. Very few of the men came from London. The vast majority came from Scotland and Ireland and the north. Drug taking was unknown. They were a highly moral group and very punitive about ‘pill pushers’. They were not always over-keen to take the tablets prescribed by the GP. Mental health was not an issue but now is talked about a great deal, which may be one consequence of the care in the community policies not even on the horizon in 1966. So in many ways the scene has changed. But then there are organizations like St. Mungo's and those running wet shelters where it is easy to see the kind of men with which the ARP was concerned from the outset. Incidentally, violence was almost non-existent. I spoke to a young worker recently who had read Vagrant Alcoholics who said ‘there's a lot in your book we haven’t done yet’, so there is clearly some sense of continuity.
A: Do you think there is a case for looking at this group in particular as part of a national strategy?
TC: To some extent the government's rough sleepers initiative has tried to do that, although as I mentioned this group is now rather harder to define. With the current discussion about making begging a criminal offence one might argue that the strategy is more about ‘cleaning up’ than getting to the roots of the problem. The group represents different challenges, and I am sure that if they are not tackled as a separate group they will lose out because government funders will not see good enough results.
A: Would you advise a young person to go into this now?
TC: I certainly would, although not by reference back to how exciting it was in my day. Times have changed and anyone starting today is at a totally different point from 1966. Although there are some enormous difficulties around funding arrangements, for example, there are still incredible opportunities in the voluntary sector to put into effect one's ideas, and to be working in areas where the statutory services only have a limited role to play. In the field of addiction there is no doubt that major services are spearheaded by the voluntary sector. There is a freedom and excitement about the voluntary sector that I experienced and then saw repeatedly in others when I was at the foundation. Young people see this too and scarcely need advice to go into it!
THE MYSTERY OF RECOVERY
A: You still seem to be working through what the ARP experience meant for you.
TC: Yes. I am still learning from events that took place during my time at the ARP. I will finish by describing a meeting I had recently with Bernie McGovern, who was a resident in one of the houses in 1970, stayed for 2 years, left and after a time returned to Scotland, married and has stayed sober for 30 years. I recently re-established contact with him and he came down to London to stay with me. Naturally, we reminisced about the good old days. He then mentioned a particular incident that I’d never heard about and that illustrated a quite profound point about the recovery of the alcoholic and the limited role that perhaps we play in it. He said that after 6 months at the house he walked into a pub on Clapham Common, and went up to the bar. When asked what he wanted he walked to the door, but returned to the bar a second time and a third. He finally ordered an orange juice but before he could drink it he walked out. That was the closest he ever came to drinking again. He is not easily able to explain why he went into the pub and why he left. For him it was the critical moment in his recovery. I never heard about this event until now. Recovery is a huge battle with many such defining moments, and although statistically Bernie goes down as one of the great successes it is hard to know just what part we played. So for me almost 40 years after I moved into Rathcoole House the mystery of recovery remains, and I am glad that it does.
‘So for me almost 40 years after I moved into Rathcoole House the mystery of recovery remains, and I am glad that it does.’