Treatment & Recovery
Integrating Professional & Recovery-Orientated Principles
Mark Gilman
Strategic Recovery Lead
National Treatment Agency
The New Public Health 1987
Public Health & Asset Based Recovery 2011
1. Make Contact
2. Maintain Contact
3. Make Positive Lifestyle Changes
Whole family and community based solutions:
“I can’t but WE can”
Big Ideas
SANITATION
Asset Based Community
Development
Why remodel the systems?
Social Isolation
ME
MYSELF
I
Me, Myself and I – in treatment and alone
Rediscovering AA:
Recovery 1935; “The Enlightenment”
"The therapeutic value of
one addict helping
another”
(See Griffith Edwards
On Lifeline’s FEAD)
75 years on:
“more than 2
million members”
Wikipedia
“I cant but WE can”
“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
bridging the gap…
Recovery
Community
Treatment
Community
bridging the gap…prison to recovery
HMP
Treatment
Recovery
Wing
Recovery
Community
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
Vertical and Horizontal Co-Production of Recovery
New Presentations (including “recyclers”) - Down and Across
Start
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TREATMENT
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Treatment
Plan
Recovery
Plan
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ACROSS
5 ways to well being
“You alone can do it but
you can’t do it alone”
Monday, 13 April 2015
I
Increase
Successful
Completions
“Those who
successfully
complete
don't hang
around”
Long term, in treatment population
Long term, in treatment population -
Social Isolation
ME
MYSELF
I
Me, Myself and I – in treatment and alone
Alive and out of prison
But:
- Health Apathy
- Marmot, Health Inequalities gap?
- Inter-Generational transmission?
5 ways to well being in Recovery
1. Connect… With people around you. Go to meetings (AA, NA, CA, SMART)
2. Be Active…do something, go for a walk, exercise, do anything.
3. Give… Do something for someone else. Volunteer.
4. Keep Learning… Try something new. Become a student of recovery?
5. Take Notice… Be curious. Be present. ‘The Power of Now’.
Vertical and Horizontal Co-Production of Recovery
Long term, in treatment population – Up and Across
TREATMENT
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5 ways to well being
“You alone can do it but
you can’t do it alone”
ACROSS
T
I
Recovery
Plan
U
P
Treatment
Plan
Review
Long term, in treatment population Mark Gilman,Monday, 13
April 2015
M
E
Social Isolation
Treatment Plan Review
Recovery Communities
Risky and Ambitious?
“A life beyond your wildest dreams”
5 Ways to System Transformation
Timetable
1. Commissioners write to all providers to
articulate recovery vision
2. Providers write to and train all staff in
Recovery Oriented Drug Treatment
(Professor John Strang report)
3. Providers implement Co-Production of
Recovery model for all new and recycled
patients/clients
___________________?
___________________?
___________________?
___________________?
4. CJS services focus on X number of DIP and
Prison “frequent flyers”
___________________?
5. Providers write to all long term patients to set
up Treatment Plan Reviews
Monday, 13 April
2015
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)
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.
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
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”)
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
•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))
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
“We are family!”
Hard Wired to Attachment
“We may not need everybody but all of us need somebody”
Is Recovery a process of Emigration & Immigration?
“We’d like to thank
community treatment for
keeping us alive and out
of prison”
RECOVERY LAND
RECOVERY
COMMUNITY
Treatment and Recovery: Content, Themes & Characteristics
Treatment:
Recovery:
Acute Short Term interventions
Long term process
“I” for Individual, Individualism
“We” as in Community, Mutualism
Medical & Clinical
Social & Communal
Risk Averse
Embraces Risk
Apathetic
Ambitious
Talking therapies
Activities “Doing stuff” (walking, sport)
•Aftercare
•Day Programmes (CBT)
•12 Step Mutual Aid (NA, CA, AA)
•SMART Recovery (CBT)
Residential Treatment
Recovery Housing & Employment
Professionals as Experts
“Recoverees” as Experts
Recovery Pioneers & Champions
Rec
ove
r
y
ENT
M
T
A
E
TR
RECOVERY
CHAMPIONS
&
QUALITY
CONTROL
Is community treatment part of the world of:
Active Addiction or Recovery Community?
“Where do I find
this recovery
stuff?”
Recovery
Communities
Community
Treatment
The Lifestyle of Active Addiction
The Lifestyle of Recovery
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)
Recovery does slowly
what 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...
PHP 5 year Treatment and Recovery Program
Skipper 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
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
PHP 5 year Treatment and Recovery Program
Total Participants
900
Number on Opioids
300
Number injecting Opioids
150
Number placed on methadone
1
Q. Who’s on this PHP?
A. Addicted Doctors
Physician
Health
Programme
“The Power of Recovery”
(Personal communication with Phillip Valentine, Executive
Director, CCAR, Connecticut Community for Addiction Recovery)
“5 years+
In recovery”
“Recovering People”
Potential
“Normal
People”
“Early Recovery”
Time
“Long Term Recovery”
“Better than well”
“A grateful
addict/alcoholic”
“Model citizens”
Deficit Based Approach
Asset Based Approach
Weaknesses
Strengths
Outside In
Inside Out
Dependence on outside Professionals
Dependence on each other
Consumers of services
Partners in provision of services
Professionals non-judgemental
training makes challenge difficult
Challenge each other to “do the right
thing”
Disabilities
Abilities, capacities, Assets
Client
Citizen
Passive victim of problems
Active participant in solutions
Treatment - Recovery - ABCD
Commissioned
Treatment
Recovery
Includes AA, NA, CA
SMART
ABCD
Asset Based
Community Development