Treatment & Recovery Integrating Professional & Recovery-Orientated Principles Mark Gilman Strategic Recovery Le

1. Treatment & Recovery Integrating Professional & Recovery-Orientated Principles Mark Gilman Strategic Recovery Lead National Treatment Agency

2. The New Public Health 1987 Public Health & Asset Based Recovery 2011

3. Big Ideas SANITATION Asset Based Community Development

4. Why remodel the systems?

5. Social Isolation ME MYSELF I Me, Myself and I – in treatment and alone

6. Rediscovering AA: Recovery 1935; “The Enlightenment” (See Griffith Edwards On Lifeline’s FEAD) "The therapeutic value of one addict helping another” 75 years on: “more than 2 million members” Wikipedia “I cant but WE can”

7. “I cant but WE can” Recovery Champions and Community as Method, (ref: George De Leon) • Active addiction is about ME, ME, ME - “Self will run riot” • A dark and lonely place; “poor me, poor me, pour me a drink” • Recovery is about a group, a community, of people coming together to find a common solution – sharing our “experience, strength and hope” • “We can do things together, we cannot do alone” • “Your recovery is my recovery” • Coming together to change lifestyles and identities • Treatment is an episode in the recovery process • If recovery was a journey from Manchester to London treatment is taxi to station

8. Recovery Community Treatment Community bridging the gap…

9. Recovery Community bridging the gap…prison to recovery HMP Treatment Recovery Wing

10. A Therapeutic Community Perspective (George De Leon cont’d) “RIGHT LIVING” • Recovery beliefs and values for social learning, personal growth and healthy living include: • Truth and Honesty • Here and Now – “The Power of Now” (its all we’ll ever have) • Personal Responsibility for Destiny (be the revolution you want to see) • Social Responsibility ("Brother's/Sister's Keeper") • Moral Code Concerning Right and Wrong Behavior • Work ethic – “The Fairy Jobmother” - Recovery Guru? • Inner Person is "Good", but Behavior Can be "Bad" • Community as method teaches individuals to use the community to change themselves

11. Vertical and Horizontal Co-Production of Recovery New Presentations (including “recyclers”) - Down and Across Start TREATMENT R E C O V E R Y C O M M U N I T Y • Increase Successful Completions • “Those who successfully complete don't hang around” T I M E Treatment Plan D OW N Recovery Plan ACROSS 5 ways to well being “You alone can do it but you can’t do it alone” Long term, in treatment population

12. Long term, in treatment population - Social Isolation ME MYSELF I Me, Myself and I – in treatment and aloneAlive and out of prisonBut:- Health Apathy- Marmot, Health Inequalities gap? - Inter-Generational transmission?

13. 5 ways to well being in Recovery • Connect… With people around you. Go to meetings (AA, NA, CA, SMART) • Be Active…do something, go for a walk, exercise, do anything. • Give… Do something for someone else. Volunteer. • Keep Learning… Try something new. Become a student of recovery? • 5. Take Notice… Be curious. Be present. ‘The Power of Now’.

14. Vertical and Horizontal Co-Production of Recovery Long term, in treatment population – Up and Across TREATMENT 5 ways to well being “You alone can do it but you can’t do it alone” R E C O V E R Y C O M M U N I T Y T I M E ACROSS Recovery Plan U P Treatment Plan Review Long term, in treatment population - Social Isolation

15. Treatment Plan Review

16. Recovery Communities Risky and Ambitious? “A life beyond your wildest dreams”

17. 5 Ways to System TransformationTimetable Commissioners write to all providers to articulate recovery vision Providers write to and train all staff in Recovery Oriented Drug Treatment (Professor John Strang report) Providers implement Co-Production of Recovery model for all new and recycled patients/clients CJS services focus on X number of DIP and Prison “frequent flyers” Providers write to all long term patients to set up Treatment Plan Reviews ___________________? ___________________? ___________________? ___________________? ___________________?

18. The Management Challenge • Employee satisfaction, patient experience, recovery outcomes. • Organisational ethos and culture more important for recovery outcome than any patient/client characteristic. • Organisational Readiness for Change (ORC): Staff must accept need for change and believe that the initiative will work. • Assertive linkage to communities of recovery: • “The addition of just one abstinent person to a social network increased the probability of abstinence for the next year by 27%” (p230) • 27% • Litt et al – “Changing network support for drinking” (2009)

19. Framingham Heart Study, Christakis and Fowler Surround yourself with Recovery • A person’s odds of becoming obese increased by 57% if they had a friend who became obese, with a lower risk rate for friends of friends, lower again at three degrees of separation • Smoking cessation by a spouse decreased a person’s chances of smoking by 67%, while smoking cessation by a friend decreased the chances by 36%. The average risk of smoking at one degree of separation (i.e., smoking by a friend) was 61% higher, 29% higher at two degrees of separation and 11% higher at three degrees of separation.

20. Line = a relationship between two people more embedded = central less embedded = periphery Node = a person “embedded”: the degree to which a person is connected within a network

21. Terms • Contagion: what flows across ties • (germs, money, violence, fashions, • organs, happiness, obesity, etc.) • Connection: • who is connected to whom • (ties to family, friends, co-workers, etc.) • Homophily: • the tendency to associate with people who resemble ourselves • (“love of being alike”)

22. The Obesity “Epidemic” • 66% of Americans are overweight or obese • From 1990 to 2000, the percentage of obese people in the USA increased from 21% to 33% Donut Or Lettuce for Lunch? Green Node: nonobese Yellow Node= obese (size of circle is proportional to BMI) 1975 1990

23. Creating Recovery Communities • Changing Social Networks • Organising Recovery Communities • “The addition of just one abstinent person to a social network increased the probability of abstinence for the next year by 27% • Litt et al – “Changing network support for drinking” (2009, (p230))

24. Rosenquist, Murabito, Fowler and Christakis (2010) – from the Framingham Heart Study • 12,067people with data collected every 2-4 years • Principals are 50% more likely to drink heavily if a person they are directly connected to drinks heavily; 36% more likely at two degrees of separation; 15% at three degrees of separation. • People are 29% more likely to abstain if someone they are directly connected to abstains. This effect is 21% at 2 degrees of separation; 5% at three degrees of separation

25. “We are family!” Hard Wired to Attachment “We may not need everybody but all of us need somebody”

26. Is Recovery a process of Emigration & Immigration? “We’d like to thank community treatment for keeping us alive and out of prison” RECOVERY COMMUNITY RECOVERY LAND

27. Treatment and Recovery: Content, Themes & Characteristics Treatment: Recovery:

28. Recovery Pioneers & Champions

29. RECOVERY CHAMPIONS & QUALITY CONTROL

30. Recovery Communities Community Treatment Is community treatment part of the world of: Active Addiction or Recovery Community? “Where do I find this recovery stuff?”

31. The Lifestyle of Active Addiction

32. The Lifestyle of Recovery

33. Recovery; Titanic and cost of a Big Book Were first-class passengers on the titanic twice as likely to survive (“Recover?”) as the average passenger? Price of Big Book = £17,200? Price of Big Book = £1.72? (+p&p)

34. Recovery does slowlywhat drink and drugs do fast... ...changes perception of reality. Learning how to fit in To live life on life’s terms Free from fear Free from addiction “Community as method” Recovery community a place where you learn how to live right, with other people...

35. PHP 5 year Treatment and Recovery ProgramSkipper and Dupont (2010) • Find a motivation fulcrum (a good reason to change) • Provide comprehensive initial assessment and extended treatment • Provide care management for many years • Have a high expectation for abstinence-based recovery • Assertive links to recovery support groups (NA, AA, CA, SMART) • Sustain motivation and support and where necessary, re-intervene • Reintervene at a higher level of intensity at any sign of relapse • Integrate these elements where possible within a comprehensive programme

36. PHP outcomes • 64% completed the 5-year programme • 72% of participants were working in their chosen profession at the follow-up point • 79% of participants had no positive tests during follow-up

37. PHP 5 year Treatment and Recovery Program

38. Q. Who’s on this PHP? A. Addicted Doctors Physician Health Programme

39. “The Power of Recovery” (Personal communication with Phillip Valentine, Executive Director, CCAR, Connecticut Community for Addiction Recovery) “5 years+ In recovery” “Recovering People” “Long Term Recovery” “Better than well” “A grateful addict/alcoholic” “Model citizens” “Normal People” Potential “Early Recovery” Time

40. Deficit Based ApproachAsset Based Approach

41. Treatment - Recovery - ABCD Commissioned Treatment Recovery Includes AA, NA, CA SMART ABCD Asset Based Community Development