addiction recovery, community & self help: grassroots ... · my fellowship was entitled:...

1 Sarah Vaile Fellowship Report 2011 Addiction Recovery, Community & Self-help: Grass roots, Treatment & Policy.

“With opportunity comes responsibility”

Addiction Recovery, Community & Self Help: Grassroots Treatment & Policy

A Winston Churchill Memorial Trust Fellowship Report By Sarah Vaile (nee Davies)

Recovery Cymru, Founder & Director

30th June – 10th August 2011: United States of America

[email protected] 07773 666 907 www.recoverycymru.org.uk


“Stay close to “Stay close to “Stay close to “Stay close to the trenches”the trenches”the trenches”the trenches”

“Experience is a brutal teacher, but by God do you learn”“Experience is a brutal teacher, but by God do you learn”“Experience is a brutal teacher, but by God do you learn”“Experience is a brutal teacher, but by God do you learn”

“Act as if what you do makes a difference…. it does”. William“Act as if what you do makes a difference…. it does”. William“Act as if what you do makes a difference…. it does”. William“Act as if what you do makes a difference…. it does”. William James, James, James, James, American PhilosopherAmerican PhilosopherAmerican PhilosopherAmerican Philosopher

With grateful thanks, Sarah Louise VaileWith grateful thanks, Sarah Louise VaileWith grateful thanks, Sarah Louise VaileWith grateful thanks, Sarah Louise Vaile March 2012March 2012March 2012March 2012


Acknowledgements My sincere thanks to the Winston Churchill Memorial Trust (WCMT) for offering me this life changing opportunity, for your superb team and for being patient with my interview excitement / nerves! My never ending gratitude to everyone involved in Recovery Cymru: members, volunteers, trustees, supporters and advocates: it’s a privilege to lead an exciting, dynamic and evolving recovery community. You all enrich my life. Recovery Cymru and this fellowship would not have been possible without the love and support of my family, husband and friends; you truly deserve recognition for your continued role in making this all possible. By no means least, to each and every person I met on my fellowship in the United States of America, you welcomed, challenged, supported and changed me.


ContentsContentsContentsContents Section Page Forward 5 Summary 6 Aims of the fellowship 6 Context 6 Recovery Cymru 11 My Fellowship 14 Walden House 14 Communities of Practice 16 Foundation For Recovery 23 Vermont Recovery Network 26 The MARS Project 28 Exponents 33 The Fix and Loft 101 35 Road Recovery 37 The Loyola Recovery Foundation 39 The McShin Recovery Foundation 41 Philadelphia's Dept. of Behavioural Health and Intellectual Disability Services 43 Connecticut Community for Addiction Recovery – Connecticut 48 Main findings and reflections 49 Fellowship legacy 55 Conclusions 58 Photo diary 59


Forward Forward Forward Forward If I’m honest, applying for a Winston Churchill Memorial Trust felt like a surreal dream when I was filling out the application forms. In 2009 I was recovering from a serious illness and was slowly returning to part time work in the care sector while I was still battling with the residual physical and psychological effects of my ill health. I was asked to take over facilitating a self-help recovery support group in Cardiff and I could never have predicted the impact this would have on my life! Not only did I not know, just how much I needed the group myself but I didn’t know that it would lead me to set up a recovery community charity called Recovery Cymru and lead me to apply to fly half way around the world to visit others in the ‘recovery world’ in the United States of America. I had worked for years in the drug and alcohol field and had the opportunity to talk to lots of people about the effects of substance use problems, their experiences of treatment and their journey to or towards recovery. I loved the work and three main things kept becoming apparent:

1. Overcoming adversity and in this case, recovering from a drug or alcohol problem is a process: a journey that takes time.

2. There are some good professional treatment programmes and systems in the UK but there were also some major challenges to the way in which they were delivered.

3. People were finding themselves ‘stuck’ or reliant on treatment, for lack of aftercare, independent community resources, confidence and place in which they felt they ‘fitted’.

4. True recovery is about much more than whether someone is taking a substance or not. It is about a person’s life: physical, psychological, spiritual and practical. It can be about healing the hurts of the past and finding a future that is attractive and they believe in.

5. To take something out of someone’s life, something needs to replace the void that is left. 6. Treatment can only go so far: once someone has learned the ‘tools’ of recovery, they need

to learn how to use them independently in the community. 7. One size does not fit all: treatment and recovery journeys differ from individual to individual 8. One size does not fit all: ‘a problem’, dependency, addiction, recovery, recovered, sober…

every term is valid and each one will not apply to all people 9. Despite this diversity, there are certain things which can bond people together to continue

their own journey in the presence of others. For me, having worked in the drug and alcohol field, experienced a recovery journey myself and being convinced of the power of community; a vision for a self-help, mutual-aid recovery community for people overcoming drug, alcohol and associated mental health problems began to form. I read with interest and excitement about the USA recovery movement and began to explore ideas with people in Cardiff. These ideas started from being aware that there was a need for independent on-going aftercare for people leaving drug and alcohol treatment services. People repeatedly informed me that there was little or no alternative to 12-step recovery programmes of Alcoholics Anonymous and Narcotics Anonymous. For people who did not find these networks appropriate, they often found themselves alone and in a cycle of relapse. A number of us became convinced that there was a need for a dynamic community providing:

• Shared experience and understanding • Self-help, mutual aid and support • Social networks • A purpose and a passion


• New skills, interests and meaningful activity • Positive ways to fill time • An ‘all pathways to recovery’, self-defined recovery philosophy • A vehicle through which to challenge stigma, discrimination and prejudice

Thus, Recovery Cymru was born and my fellowship application complete… Summary Summary Summary Summary My fellowship was entitled: ‘Addiction recovery, self‘Addiction recovery, self‘Addiction recovery, self‘Addiction recovery, self----help and community: grasshelp and community: grasshelp and community: grasshelp and community: grass----roots, treatment and policy.’ roots, treatment and policy.’ roots, treatment and policy.’ roots, treatment and policy.’ I visited six states in America, over six weeks in July and August 2011, visiting recovery projects, treatment providers and strategists. I also spent a week on a ‘communities of practice’ workshop with people from business, health and education projects who were interested in how communities of learning develop. Aims of the fellowshipAims of the fellowshipAims of the fellowshipAims of the fellowship My main aims of the fellowship were to gain knowledge, skills, inspiration and expertise to develop Recovery Cymru and to contribute to the growing recovery movement in Wales by: 1. Learning best practice by visiting a range of established peer-led recovery projects 2. Learning about organisational development by talking to founders and coordinators of self-help

peer organisations 3. Talking to people involved in the strategy, policy and implementation of recovery oriented

treatment pathways

I was particularly interested in the interface between the treatment system and recovery community projects and the role of peer based recovery support services. Where are these communities in which recovery is lived and where are these ‘services’ carried out by peers? I was also hoping for a period of reflection in which I could process the rapid development of Recovery Cymru and consider the right way ahead for the future. I wanted to better formulate the vision for Recovery Cymru and ways in which to make the community sustainable. Context Context Context Context The United Kingdom has the highest level of dependent drug use and among the highest levels of recreational drug use in Europe. The drug problem steadily worsened over the last quarter of the twentieth century: the number of dependent heroin users increased from around 5,000 in 1975 to a current estimated 281,000 in England and over 50,000 in Scotland. Since the turn of the millennium, drug trends have shown signs of stabilisation, albeit at historically high levels. Statistics taken from Welsh Government Substance Misuse in Wales Reports and Alcohol Concern report that:

• In Wales, there were 7, 500 referrals for treatment of alcohol or drug misuse notified to the WNDSM between April – June 2011.

• In Wales, 54% (4, 100) related to misuse of alcohol, 36% (2, 700) related to misuse of drugs and 9% (700) of referrals had no main substance reported.


• It is estimated that for every problem drug / alcohol user another 3 individuals are significantly affected

• Alcohol accounts for around 1,000 deaths in Wales per year • 15% of hospital admissions in Wales are due to alcoholic intoxication • 30,000 hospital bed days each year are attributable to the consequence of alcohol

consumption • There were 15,314 referrals for alcohol misuse in Wales in 2010/11, including 1,218 for

patients aged 19 or younger • The cost to the NHS in Wales of alcohol-related chronic disease and acute is between £69.9

million and £73.3 million each year. A National Treatment Agency (England, 2012) document reports that

• 1 in 3 adults have taken drugs at some point • About 1 in 10 have used drugs recently • 1,200,000 people are affected by drug addiction in their families • Every year it costs society £15,400,000,000 • Alcohol causes 35,000 deaths per year • Drugs cause 1,600 deaths per year

It is clear that people like to change the way they feel. For some people this is done via exercise, good food, time spent with friends, adrenalin activities, escapism into films, sex and of course, drinking and using drugs. There appears to have been an anecdotal rise in the latter, with more attention being paid to the ‘binge drinking’ culture in the UK. For some people, what starts as recreation and relaxation turns into dependency, addiction and learned patterns of behaviours which entrench the use of substances to make people feel normal, relaxed, comfortable. It is worth noting that there are many more people in the UK than we are aware of who experience this. Society likes to believe ‘these people are different’; ‘I’d never end up sleeping on the streets’, ‘why don’t they just stop’. The Welsh Government have demonstrated a clear commitment to an integrated recovery-oriented model of treatment for drug problems, which represents a significant change in focus toward a more person-centred and individualized philosophy for the delivery of drug treatment in the United Kingdom. So where has this impetus for recovery come from? In international terms, there are two primary sources: The first is the work of the Betty Ford Institute Consensus Panel (2007) defining recovery as “a voluntarily maintained lifestyle [characterized] by sobriety, personal health and citizenship” (p. 222). The paper goes on to differentiate stages of recovery, classed as “early sobriety” (the 1st year), “sustained sobriety” of between 1 and 5 years, and “stable sobriety” of more than 5 years. The second source is the work of William White, who in the monograph, Peer-Based Addiction Recovery Support, describes recovery as consisting of three elements: “sobriety (abstinence from alcohol, tobacco, and unprescribed drugs), improvement in global health (physical, emotional, relational and ontological—life meaning and purpose), and citizenship (positive participation in and contribution to communal life)” (2009a, p. 16). Additionally, the growth and perceived success of a service user-driven movement for mental health both in the United Kingdom and internationally, as well as the growth and diversification of mutual aid groups,1 supported by an increasingly compelling body of evidence about their effectiveness (Humphreys, 2004)2, has led policymakers at a local and national level to assess the recovery activity


in local communities that is rich and diverse and that is progressing irrespective of funding support or research endorsement. There are enough addiction theories to support the number of different ‘categories’ people may find themselves in: a born condition, a predisposition, hereditary, disease model of addiction, a medical model of addiction, learned behaviour, brain damage and the list goes on. It is important to remember that although these theories are important in understanding, preventing and overcoming ‘addiction’, there are real people, with real lives, personalities, families, jobs, hopes and aspirations behind them. For some time now, much of the focus of treatment and policy has been upon reducing the risk of harm to the individual and society as a result of substance use problems. This has relied upon a medical model of addiction, which focuses on crisis management, long term treatment and incarceration. Traditionally, most of the focus has been on the provision and completion of ‘treatment’. Treatment can be described as a professionally delivered service to help individuals to reduce or stop their problematic drug and alcohol use. Whilst this can often be a key intervention in an individual’s recovery journey, traditionally, so much focus has been placed upon treatment that little attention has been given to what happens once this process is over or how treatment services and systems can be improved. Treatment has traditionally followed an ‘Acute care and medicalised model’, meaning people often fall into an acute or crisis category to enter treatment and the approach taken has historically been focused upon reducing harm to the individual and community and dealing with crisis. Although this is important, it has led to a system which often overlooked the longer term goal of long term recovery and sustained independent living in the community. The UK recovery movement has been instrumental in changes to the way treatment is approached and delivered in the UK. However, there is still more work to be done! The recovery movement The recovery movement The recovery movement The recovery movement There is a growing recovery movement in the UK, which aims to mobilise and empower groups of recovering people to develop peer support, to raise awareness of recovery, to act as a voice for those who are disadvantaged because of their substance misuse problems and to advocate for recovery oriented treatment. Recovery principles set out by the Centre for Substance Abuse Treatment (2009) are at the heart of the recovery movement.

• There are many pathways to recovery. • Recovery is self-directed and empowering. • Recovery involves a personal recognition of the need for change and transformation. • Recovery is holistic. • Recovery has cultural dimensions. • Recovery exists on a continuum of improved health and wellness. • Recovery emerges from hope and gratitude. • Recovery involves a process of healing and self-redefinition. • Recovery involves addressing discrimination and transcending shame and stigma. • Recovery is supported by peers and allies. • Recovery involves (re)joining and (re)building a life in the community. • Recovery is a reality


The growing UK recovery movement recognises the need for changes to the traditional addiction treatment services to become more ‘recovery focused’. To do so, it is argued that the system needs to move away from focusing on an acute care model and instead, view addiction as a chronic condition which needs recovery oriented systems of care to provide a range of treatment and aftercare opportunities for people to recover. The recovery model differs from the medical model, on which much of addiction treatment is currently based, in that it 'emphasizes empowerment of the person, the importance of peer support, and involvement of family members in helping the person find recovery. It focuses on strengths and assets of a person, not their weaknesses and deficits, and goes beyond symptom management.' Recovery is about people building or rebuilding meaningful and valued lives, where they can realise their aspirations, be treated with respect and dignity, and contribute to society. “A recovery-oriented system supports person-centred and self-directed approaches to care that build on strengths and resilience. Individuals, families, and communities take responsibility for their sustained health, wellness, and recovery from alcohol and other drug related issues through the various life phases of recovery. This system refers to a macro-level organization of the larger cultural and community environment in which long-term recovery is nested and offers a complete network of formal and informal resources that support long-term recovery of individuals and families” Pennsylvania Drug and Alcohol Coalition White paper, 2010 “Central to the notion of developing a recovery model is the idea that empowerment and ownership of the process increasingly resides with individuals, families and communities. One of the key challenges in the United Kingdom at a systems level is to attempt to address interagency working as genuine partnership but also to tackle organizational cultures that are resistant to such approaches. This has, at its heart, key principles of:

• Multi-disciplinary working. • No single organization having “ownership” of cases. • Client at the centre of the treatment process. • Training and supervision for workers based around active client engagement. • Rapid transition from professionally directed treatment plans to client-directed recovery

plans. • Treatment systems commissioned to incorporate joint working. • Real pathways for clients and real choices right from the start. • Community, family, and peer participation in recovery and treatment programs.

Role of the practitioner: Although there has been a longstanding movement to place the client in charge of their care plan, the recovery model requires professionals to take a further step to work alongside their clients in a coaching role. It also means a shift in roles with professionals moving from being the “directors” of change through clinical intervention to facilitators of a self-directed change that is grounded in the family home and the local community, not the hospital or clinic. (UK Recovery Academy, 2011)

Recovery is a process that occurs in the community with others Treatment may be one part of this process More active ownership of the treatment process by individuals undergoing the process Greater emphasis on long term goals and aspirations vs. symptom management Interventions based on strengths and hope Switch from an acute model of care to a long term recovery model


Professionals play a critical role in enabling and supporting the early stages of recovery journeys

The expertise of lived experience, families and communities have a core role to play in sustaining recovery

Recovery Oriented Integrated Systems - services are not isolated pockets of care but should form a ‘greater whole’

Timely & appropriate: access, referral, assessment, treatment options, recovery plans. E.g. opening hours, joint care plans

Planning for exit Nurturing the development of and partnerships with the recovery community, peer-led

activities and other community-based support. Case management Treatment and post treatment monitoring & support Early re-intervention and re-linkage to treatment and recovery supports

The recovery movement: Grass roots recovery communitiesThe recovery movement: Grass roots recovery communitiesThe recovery movement: Grass roots recovery communitiesThe recovery movement: Grass roots recovery communities The discussion about how treatment should change has sparked an exciting explosion of grass roots, peer-led recovery support initiatives around the UK. This element of the recovery movement aims to mobilise people in recovery, their families and advocates to develop meaningful recovery support options in the community. These community assets provide a genuine opportunity for people to live a life of recovery in their own communities, to put a face a voice on recovery and to offer peer support to others to help them on their recovery journeys. The recovery movement is proof that recovery is real, possible and is about more than whether someone is taking a substance. It is a ‘whole-person’ journey which can touch upon every area of an individual’s life; essentially it is a bio-psycho-social ‘life’ process which occurs in the community. The UK recovery movement, driven by people in recovery and advocates, recognise the need for:

• Peer based recovery support • On-going recovery support in the community • Aftercare for people leaving treatment • Awareness of different recovery philosophies and outlooks • The need to put a face and a voice on recovery: to show others that recovery is possible and

to challenge stigma and discrimination • Peer support and mutual-aid options, including but not exclusively, the fellowships of

Alcoholics Anonymous and Narcotics Anonymous Recovery definitionRecovery definitionRecovery definitionRecovery definition The term recovery itself has arguably long been associated with the fellowships of Alcoholics Anonymous 12-step treatment culture and as such a strict abstinence philosophy. For some people and practitioners, this has been a major barrier to them accepting some of the terminology and arguments of the recovery movement in the UK. The USA treatment and recovery movement has traditionally been associated with 12 step recovery and for the UK, with a long history of harm reduction and cognitive behavioural approaches; this has been a major sticking point. As such, there are on-going discussions to produce a definition of recovery that encompasses and supports all recovery philosophies (including 12 step recovery) whilst also remaining meaningful. A Recovery


definition should embrace and encourage all philosophies and models. One size does not fit all and our beliefs and definitions of recovery need to reflect this. Definitions include: A UK “vision” of recovery characterized as “voluntarily sustained control over substance use which maximizes health and [well-being] and participation in the rights, roles and responsibilities of society”. The report emphasizes the range of routes to recovery and also suggests that this includes “medically maintained abstinence” (UK Drug Policy Commission (UKDPC) Consensus Group 2007) Recovery involves a commitment to a move toward health, strengths, and wellness. It has hope and aspiration as core features, with self-management encouraged and facilitated (Slade, 2009). Recovery from alcohol and drug problems is a process of change over time that facilitates an individual to make positive choices and improve the quality of his or her life. (Welsh Government recovery advisory panel, 2012) Recovery CymruRecovery CymruRecovery CymruRecovery Cymru Recovery Cymru is a fast-growing organisation established as a charity in January 2011 and is a mutual-aid support community in Cardiff for people in or seeking recovery from drug and alcohol problems. We are passionate about developing and strengthening communities of people recovering from drug and alcohol problems. Together, we empower and support people to initiate and continue their recovery journey, to pursue fulfilment, to explore their skills and interests and to improve their quality of life. Through the power of shared experience and understanding, people can support themselves and others. Our members are people who have personal experience of drug and alcohol and are ‘on’ their recovery journey, ‘recovery champions’ such as family members, volunteers and workers; as well as members of the general public who simply like what we do! Our activities are designed and run by people in recovery, are laid-back, positive and recovery-focused. We develop groups, activities and social networks that offer people the chance to be a part of a genuine community of:

• Self-help, support, advice and friendship • Positive and meaningful ways in which to spend time • New skills, hobbies and community networks • Relapse prevention/management • Awareness raising, advocacy and community building • Training, volunteering and social enterprise

Recovery Cymru is built upon the conviction that recovery is a journey which is a lived experience within the wider community. People in recovery from problems with drugs or alcohol are notoriously prone to relapse. There is any number of reasons for this; not least among them is the stigma that is often attached to those who have once been labelled ‘drug addicts’ or ‘alcoholics’. People in recovery are sometimes told that they are incapable of change and beyond reform, messages that can become self-fulfilling prophecies if not countered with a message of hope. Further factors which are commonly cited among the complex of reasons for relapse are lack of direction or opportunity for the future, and low self-esteem. For many people a considerable proportion of their lives have been dominated by problems with drugs or alcohol and they may have had no goals during that time beyond the acquisition and consumption of drugs or alcohol. For


some, an important task of recovery is to rediscover their long-term plans and ambitions, for others it is to discover the ability to look beyond the next drink or drug for the first time in their lives. This can be a daunting task at the best of times, but particularly at a time when someone is attempting to make a number of other important and positive changes to their lives. It can be made even more discouraging because some opportunities for personal development are difficult for people in recovery from problems with drugs or alcohol to access. We are committed to and proud of our inclusive recovery philosophy, which supports:

• Recovery as a journey • All pathways to recovery: all treatment models and philosophies • Self-defined recovery, including abstinence and non-abstinence-based recovery • Medication-assisted recovery • A strong belief that everybody has something to both receive and contribute to the recovery

community, from day one. You don’t have to wait until you’re fixed to find a purpose and passion!

• A focus on positive and healthy life patterns and social relationships. Recovery Cymru has a number of aims, both for individuals, the community and wider society. These are:

• To build networks of community-based recovery support • To advocate for recovery oriented treatment systems • To challenge stigma and discrimination

As such, we are delighted to be involved in projects in Wales, such as, recovery networking, the redesign of treatment delivery in Cardiff and the Vale of Glamorgan, community advocacy events, and training opportunities. The following diagram gives more details of the day-to-day activity of Recovery Cymru:


Buddy system

Recovery events

Self-help

Community socials

Giving talks

Advocacy

Publicity

Fundraising events

Awareness raising Reducing stigma

& discrimination

Local charities & community

groups

For-Matt Music group

Facilitating groups

Training

1:1 support

C-Change

Allotment group

Qualifications

Raising awareness

Representing Recovery Cymru

Family & friends

New social networks

Community integration

Sharing stories

Creative expression

group

Exercise groups

Outdoor activities

Welcoming new members

Women’s group

A role for everyone


My Fellowship: Projects visitedMy Fellowship: Projects visitedMy Fellowship: Projects visitedMy Fellowship: Projects visited Here is an overview of the main learning points from the individual projects I visited during the fellowship. The following section covers learning points that spanned across several projects and locations. Walden House Walden House Walden House Walden House –––– San Francisco, CaliforniaSan Francisco, CaliforniaSan Francisco, CaliforniaSan Francisco, California

To address the thousands of adolescents and young adults that were streaming into San Francisco for the cultural revolution of the 1960’s, Haight Ashbury Free Clinics (HAFC) opened its doors in 1967 as the first free medical clinic in the country. During the first week of operation over 400 patients were seen. HAFC has been an innovator in delivering primary health care services to many of the people who can least afford them. “Health Care is a Right, Not a Privilege” has been the guiding principle as well as its famous tagline. Walden House was founded in 1969 by Walter Litrell in the same Haight-Ashbury district of San Francisco to help homeless and runaway adolescents with substance abuse problems.

Today, Walden House treats people with mental health and substance abuse problems at various residential and outpatient centres throughout California, including in-prison treatment programs, and facilities in San Francisco and Los Angeles, providing drug and alcohol treatment and mental health, vocational and housing services for people transitioning back into their communities. Like HAFC, Walden House has always served people who are uninsured, homeless and socio-economically disenfranchised, including those with HIV/AIDS. Main points of interestMain points of interestMain points of interestMain points of interest Walden House have a thriving ‘alumni programme’ which enables graduates from the programme to continue to support each other and share their experiences with newer members of the programme. It was interesting to hear how this is ’managed’ by Walden House. People want to use their experiences to help others and it is known to reinforce their own recovery journey. From an organisational point of view, communication seemed to be the key. Keep in touch with people, connect people, coach people in how to support others, develop practical structures, and encourage and support people. Walden House have a policy of ‘tracking’ their ex-clients, keeping in touch to see how they are and offering them opportunities to share their stories with others Walden house also run a parolee programme for ‘high risk categories’, which runs from 8.30am 'til 9pm, 7 days per week, ‘to best suit the needs and risks experienced by the people we are reaching out to’. As a recovery community, Recovery Cymru is developing networks and infrastructure to enable an increasing number of peer-led activities, social networks and activities to develop in the ‘real life’ times. Evenings and weekends can be difficult, lonely and boring times for people in recovery, particularly during the early stages. It’s when many services and support structures are closed – and times which used to be filled by using or drinking. Our aim is to empower people to find positive ways of using this time. This is also pertinent for those involved in the design and delivery of treatment and recovery services.


Learning Learning Learning Learning 1. It doesn’t happen by accident. A well thought through system is needed to keep a network

of alumni’s in touch with the service and to offer them opportunities to help new ‘recruits’. This is applicable to Recovery Cymru and treatment services in the UK. Keeping in touch does not necessarily mean ‘keeping tabs’. It can have a number of benefits, mainly • Simply keeping in touch keeps people connected, giving them the opportunity to seek

further assistance should they need it • Collecting longitudinal outcomes • Networking ‘graduates’, encouraging them to develop peer networks in the community

and offering opportunities for them to share their stories and experiences with others. • Offering hope and evidence of recovery to those seeking help

2. Enhancing access, reducing risks and barriers

The parolee programme is an example of designing treatment and rehabilitation programmes to best fit the needs and lifestyles of those they are designed for. Services are often run between 9am and 5pm. Re-assessing these hours could have two major benefits:

• Increasing access for those who are in employment or have childcare issues during the day

• Reducing the ‘void’ of time in which people can find themselves more at risk for relapse, isolation and other behaviours because many services and support structures are closed.


Communities of Practice Communities of Practice Communities of Practice Communities of Practice –––– Grass Valley, CaliforniaGrass Valley, CaliforniaGrass Valley, CaliforniaGrass Valley, California I was fortunate to have the opportunity to participate in a week long BEtreat in Grass Valley, California to learn more about ‘Communities of Practice’ with Etienne Wenger and Bev Trayner. Communities of PracticeCommunities of PracticeCommunities of PracticeCommunities of Practice “Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.” Communities of practice are formed by people who engage in a process of collective learning in a shared domain of human endeavour: a tribe learning to survive, a band of artists seeking new forms of expression… a gathering of first-time managers helping each other cope. Not everything called a community is a community of practice. Three characteristics are crucial: The domain A community of practice is not merely a club of friends or a network of connections between people. It has an identity defined by a shared domain of interest. Membership therefore implies a commitment to the domain, and therefore a shared competence that distinguishes members from other people. The domain is not necessarily something recognized as "expertise" outside the community. A youth gang may have developed all sorts of ways of dealing with their domain: surviving on the street and maintaining some kind of identity they can live with. They value their collective competence and learn from each other, even though few people outside the group may value or even recognize their expertise. The community In pursuing their interest in their domain, members engage in joint activities and discussions, help each other, and share information. They build relationships that enable them to learn from each other. Having the same job or title does not make for a community of practice unless members interact and learn together. The practice A community of practice is not merely a community of interest--people who like certain kinds of movies, for instance. Members of a community of practice are practitioners. They develop a shared repertoire of resources: experiences, stories, tools, ways of addressing recurring problems—in short a shared practice. This takes time and sustained interaction. It is the combination of these three elements that constitutes a community of practice. And it is by developing these three elements in parallel that one cultivates such a community.

For more information, I recommend reading ‘Cultivating Communities of Practice: A Guide to Managing Knowledge’, by Etienne Wenger, Richard McDermott and William Snyder (1 Jan 2002) http://www.amazon.co.uk/Cultivating-Communities-Practice-Managing-Knowledge/dp/1578513308/ref=sr_1_2?s=books&ie=UTF8&qid=1327859442&sr=1-2


The BEtreat The BEtreat is a four day experience which gathers leaders of Communities of Practice (CoP’s), involved in organising, developing and sponsoring CoP’s to discuss, develop and share learning. It involves people from all around the world, including online and face-to-face participants, and from all sectors, including corporate, non-profit, education. I was interested to explore the different approaches (or indeed the same approaches) to cultivating communities, particularly between different sectors.

Learning Learning Learning Learning

1.1.1.1. The application of communityThe application of communityThe application of communityThe application of community I often think of recovery Cymru as offering a social learning environment in which people can learn the tools of recovery, practice the skills learned in treatment and share experience, ideas and expertise with others. As such, it is highly applicable to the work that has been developing around ‘Communities of Practice’ for the last twenty years, pioneered by Etienne Wenger. Connecting people with a shared area of interest (domain), for example, recovery, to share learning and knowledge to drive forward the community’s learning agenda (long term recovery in the community), is the essence of recovery peer support networks. We want Recovery Cymru to be a (Recovery) community of Practice (long term recovery in the community). I hope that makes sense! I am also interested in the behaviour of the wider recovery movement and how knowledge and experience can be shared between those involved in the development of recovery support and recovery oriented treatment services. There could be real potential for CoP’s to assist us to shape and drive forward some of the ideas and challenges we face. Connections and learning agendas already exist, including the Recovery Academy , the North Wales Recovery Academy, UKRF , Wired In, Addiction Recovery Foundation , Drink and Drugs News , EATA, The Scottish Recovery Consortium as well as a host of local recovery projects and Possible CoP’s and ‘domains’ of learning could include:

• Recovery Community Organisation (RCO) organisers • Development and piloting of outcome measure methods and definitions. • Recovery Oriented Systems of Care (ROSC) [Also known as ROIS – Recovery Oriented

Integrated Systems] One of the exercises for participants at the BEtreat was to develop a ‘booth’ showing an overview of each of our communities and applications of CofP’s. As I am yet to start, I gave an overview of the aspects of RC so far and some of the questions I had around the applicability of nurturing CoP’s within RC to cultivate shared knowledge and learning between peers. I also had questions about harnessing the work that many of us in the recovery world are doing around the UK (and further afield).


The opportunity to discuss the issues around cultivating and managing Communities of Practice, with colleagues from business, education, health and ‘third world’ communities was fascinating. It was also reassuring in a way to know that the issues faced are common to all sectors and modalities. The topics of relevance are listed below.

2.2.2.2. Active participationActive participationActive participationActive participation In any Community of Practice, recovery project or treatment programme there are issues around initial sign up versus active participation. We discussed ways in which the community could be harnessed to best encourage meaningful participation.

• Ask meaningful questions • Actively listen to the answers • Proactively encourage healthy practice within the community


3.3.3.3. Power, Control and the Role of the Community Leader Power, Control and the Role of the Community Leader Power, Control and the Role of the Community Leader Power, Control and the Role of the Community Leader

It is important to recognise the challenge of power, control and leadership within communities. There is a constant tension between allowing a community to be dynamic, evolving and fresh and the constraints of needing to be organised, structured and accountable. In terms of a pure Community of Practice, where does organisation stop and control take over? Should the Community itself define its learning agenda or is it appropriate for a community leader to set it? In a Community like Recovery Cymru, who makes and how are decisions made about activities, community management and future projects? At the core of everything we do is the genuine belief that ‘the community belongs to the community’. This means everyone is valued in having an opinion, a voice and a role within the community. However, this is in tension with the reality of managing and growing a diverse community which also retains its core beliefs, values and ways of working. There is also the practical element of managing the overall day-to-day structure. It appears to be a normal human tendency to create hierarchies according to power and knowledge. This can happen as much in the ‘horizontal’ as in the ‘vertical’ structure. Hierarchies of length of engagement, prior involvement, type or length or recovery, previous experience of treatment, amount of time available, natural skills and abilities can all be translated into hierarchical differences and create power imbalances in communities. It is important to recognise these imbalances and for the Community Organiser to be honest and reflective in managing them. There is little point in pretending they don’t occur. However, reflecting upon your community’s mission, values and philosophy can help you to create ways of working that minimise any negative effects and in fact maximise the potential benefits of ‘lines’ of responsibility, accountability and support.

4.4.4.4. Role of the community leader / facilitatorRole of the community leader / facilitatorRole of the community leader / facilitatorRole of the community leader / facilitator Following on from above point, the role of the Community Organiser can in itself be challenging when considering the optimum balance of organisation, control, and influence and allowing natural accountability for the community and its members? Throughout my fellowship I had many conversations about the changing roles in recovery programmes and communities. It seems to be a natural human tendency to create hierarchies and distinctions between ‘professionals’, ‘peers’, ‘coach’, ‘paid vs. nonpaid roles’, length and nature of recovery etc. Although to some extent this is natural (and sometimes necessary), it does create


potential tensions and should at all times be weighed against maintaining healthy and welcoming structures of quality within the community. As recovery communities grow, organise and sometimes become recovery community organisations (RCOs), I think we have some questions to ponder:

• Does there always have to be a pronounced hierarchy when community organisers and coordinators are paid and as different roles and responsibilities emerge?

• Does a change in role, responsibility and to some extent authority, negatively affect the ‘we’re all equal and in it together’ philosophy Recovery Cymru is based upon?

• How do we organise and develop structures within recovery communities that don’t exacerbate hierarchical boundaries

• How do we develop recovery coach roles without veering into ‘professional – client’ relationships

• Can recovery community members take on more responsibilities for ‘running’ or organising parts of the community and still be viewed as equal amongst peers?

5.5.5.5. Communicating valCommunicating valCommunicating valCommunicating valueueueue

I was struck by how the same issues were faced by all: large, small, corporate, non-profit, education. How do you show the value of your CoP, capturing the non-qualitative data values that are traditionally viewed as ‘soft’ in comparison to the ‘hard’ data of number crunching? Indeed, the very terms we use seem to convey the importance and credibility we appear to place on them (e.g. hard vs. soft). All participants talked about the balance between showing funders, sponsors & competitors the outcomes of their CofP’s and not overloading community organisers and members with laborious data collection. There appeared to be a consensual agreement about the need for quantitative data collection but a move towards qualitative stories to give ‘life’ to the value created by the CoP’s. This was reinforced by Etienne & Bev outlining their developing ‘value creation story matrix’ to support those involved in collecting and communicating value. This document outlines some of their thinking.

This is a particularly pertinent issue for the recovery movement as it strives to question:


• What are ‘success’ and ‘outcome’ indicators for recovery oriented treatment? • What are ‘success’ and ‘outcome’ indicators for recovery community projects and how can

they be demonstrated. According to value creation story matrix, outcomes and indicators of those outcomes can be demonstrated as different stages of the interaction ‘story’. Examples of indicators for each cycle include:

• Immediate: level of participation, quality of interaction, level of engagement, having fun, level of reflection

• Potential: skills acquired, inspiration, social connections, tools and documents, new views and learning

• Applied: implementation of advice, innovation in practice, reuse of products, use of social connections, new learning approaches

• Realised: personal performance, organisational performance, organisational reputation • Reframing: change in strategy, new metrics, new expectations, and institutional changes

I believe, with some careful consideration and discussion with colleagues we could use this as a basis to develop a ‘value matrix’ both for individual impact and organisational impact of recovery projects. An additional important discussion we had was around being mindful of what, how much and how we measure value and outcomes. “It’s possible for measurement to destroy the very thing you are trying to measure. “ Wise words.

6.6.6.6. WhoWhoWhoWho’’’’s your master?: Organic vs. sponsored communitiess your master?: Organic vs. sponsored communitiess your master?: Organic vs. sponsored communitiess your master?: Organic vs. sponsored communities Another pertinent discussion was had around motives for setting up communities and the issues that arise from communities being funded.

• Are there major differences between evolutionary ‘grass roots’ Communities and those that are sponsored from the beginning?

• Are there major differences between those that remain independently resourced vs. those that are funded?

• Is it possible to be independently resourced? • How do you communicate genuine value vs. the outcomes funders may be interested in, e.g.

qualitative vs. quantitative data? This is an important issue for Recovery Cymru, particularly as we grow. The community evolved from a genuine need and passion at the ‘grass roots’ level. As we have grown rapidly and the range of activities we manage has diversified we are dealing with the very real issues of sustainability, resources and management. As we consider different financial models, there is a constant tension between securing financial security whilst ‘remaining true to our roots’. Our present two year funding from the Welsh Government has offered some financial security whilst we consider different models. Being mindful of our aims, objectives and philosophy is paramount as we decide upon potential income streams.

7.7.7.7. Connecting members: faceConnecting members: faceConnecting members: faceConnecting members: face----totototo----face and online interfacesface and online interfacesface and online interfacesface and online interfaces The online component of the BEtreat was an interesting learning experience. Although there were some major challenges to mixing online and face-to-face groups, all in all, this was a very worthwhile trial. As Recovery Cymru is in the process of setting up Recovery support in the Vale of Glamorgan, Wales, which has several population hubs and rural areas, the issue of connecting groups, facilitating meetings, social networks and support mechanisms are paramount. The applicability of


technological tools such as, video conferencing, mobile technology, wikispaces (www.wikispaces.com), Facebook, twitter, forums and blogs, to the provision of self-help and recovery support is interesting. People often describe the ‘human contact’ as an important part of building trusting social and mutual-aid relationships. However, this has to be balanced with the practicalities of rural living and physical limitations and I wonder if there is a ‘best of both worlds’ programme which we could develop.

8.8.8.8. Peer learning communities and learning spacesPeer learning communities and learning spacesPeer learning communities and learning spacesPeer learning communities and learning spaces One of the Participants, Sue Smith from the UK, also presented the concept of different learning spaces, which she has identified within her CoP’s. These are (1) peer-to-peer, (2) social, (3) reflective and (4) peripheral. “The learning spaces presented provide a different way of conceptualising learning spaces and learning generally in networked learning.... Arguably, they can be seen as the effect of any peer learning community.” Learning space Attribute

Peer-to-peer learning space

Peer-to-peer learning takes places across community learning events and is experienced as a space where the delegates share their knowledge and experience.

Social learning space

The social learning space is made up of non-directive spaces (not part of the formal curriculum) such as tea breaks, lunches, sharing lifts, meals organised outside of directed community activities etc. It provides the opportunity for community bonding.

Reflective learning space

Reflection is an activity that takes place across community learning events but is perceived as a discrete space where the delegates undertake this activity individually and collectively.

Peripheral learning space

This learning space happens when the learning from Community learning events ‘leaks’ into other areas of the delegates’ lives (home, work, family etc.). This space also encompasses a future space whereby learning from learning continues once the programme has finished.

9.9.9.9. Further reading Further reading Further reading Further reading • Communities of practice: the organizational frontier. By Etienne Wenger and William Snyder.

Harvard Business Review. January-February 2000, pp. 139-145. • Knowledge management is a donut: shaping your knowledge strategy with communities of

practice. By Etienne Wenger. Ivey Business Journal, January 2004. • Supporting communities of practice: a survey of community-oriented technologies. By

Etienne Wenger. Self-published report available at www.ewenger.com/tech, 2001. • Communities of practice: learning, meaning, and identity. By Etienne Wenger, Cambridge

University Press, 1998. • Learning for a small planet: a research agenda. By Etienne Wenger, available

atwww.ewenger.com/research, 2004.


Foundation for Recovery Foundation for Recovery Foundation for Recovery Foundation for Recovery –––– Las Vegas, NevadaLas Vegas, NevadaLas Vegas, NevadaLas Vegas, Nevada Foundation For Recovery is a Recovery Community Organisation (RCO), based in Nevada, whose mission is to, promote the positive impact of addiction recovery in the community and the lives of individuals and families affected by the disease of addiction. Our programs, services, and partnerships will open pathways for recovery by removing social barriers and creating opportunities for those seeking recovery.’ The Foundation has a number of programmes to achieve this mission. They aim to:

• BE the leading non-profit organization providing knowledge, information, and original research about effective approaches and best-practices for recovery from the disease of addiction.

• UTILIZE and grow our Research and Study Centre toward being the world leader in the compilation and dissemination of information on the past, present, and future of addiction and recovery.

• EXPAND our presence in Colleges and Universities by providing scholarships to students and educators who will benefit future generations.

• CONTINUE to support professional treatment for addiction by providing scholarships for individuals and families who lack the resources to obtain these services on their own.

• BECOME a respected, sought-after voice and powerful influence with regional, national, and international businesses and governments seeking support and information about addiction and recovery in its many forms and complexities.

The Foundation has an extensive network of ‘fellowship’ groups throughout Las Vegas. Drug and alcohol treatment historyDrug and alcohol treatment historyDrug and alcohol treatment historyDrug and alcohol treatment history

It was a real privilege to spend time with Dr Bob Stewart who has collected one of the world’s largest archives of drug and alcohol treatment memorabilia and historical material. Stewart has many years’ experience in developing recovery services and being a part of the recovery movement in the USA. Looking at memorabilia documenting some of the beliefs that were held about addiction, as well as some of the ‘treatments’ trialled was a real testament to the progress that has been made in understanding the science of addiction, the concept of learned behaviour and community approaches to recovery.

I would like to learn more about the history of addiction treatment and the scientific discoveries of addiction, ‘cause’ and treatment. Empowering Recovery Cymru members with information about the theories of addiction and subsequent treatment and self-help options can help individuals to consider and find the path that is best for them. Recovery Community Recovery Community Recovery Community Recovery Community Organisations (RCOOrganisations (RCOOrganisations (RCOOrganisations (RCO’’’’s)s)s)s) “A recovery community organization (RCO) is an independent, non-profit organization led and governed by representatives of local communities of recovery. These organizations organize recovery-focused policy advocacy activities, carry out recovery-focused community education and outreach programs, and/or provide peer-based recovery support services (P-BRSS). The broadly defined recovery community – people in long-term recovery, their families, friends and allies, including recovery-focused addiction and recovery professionals – includes organizations whose


members reflect religious, spiritual and secular pathways of recovery. The sole mission of an RCO is to mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery from alcohol and other drug addiction. Public education, policy advocacy and peer-based recovery support services are the strategies through which this mission is achieved.” (The Recovery Community Organization: Toward A Working Definition and Description Phillip A. Valentine, William L. White and Pat Taylor) http://www.facesandvoicesofrecovery.org/pdf/valentine_white_taylor_2007.pdf Discussing the range of services provided by Foundation for Recovery helped me to reflect on the aims and mission of Recovery Cymru. As we evolved so rapidly from one small self-help group, these discussions enabled me to take some time out to clarify the aims that are developing into ‘programmes’ of activity and fulfil our main aims. By recognising the different functions we seek to provide at RC, helped me to better develop the project and organisational plans and therefore, where to focus community energies. National and local organisationNational and local organisationNational and local organisationNational and local organisation Foundation for Recovery is a state-wide organisation with chapters throughout Nevada. The central branch develops resources, guidance, small funding grants, ‘start-up’ guides and training for local chapters. The aim of the central branch is to provide a ‘hub’ and direction for local branches whilst empowering the local branches to evolve into what the community wants and needs in their local area whilst retaining the philosophy and culture of the overall organisation. This was an interesting conversation as Recovery Cymru seeks to empower people to develop recovery support activities and social networks within their local communities, as well as getting involved in the wider activities we run. This will become ever more pertinent as we develop groups outside Cardiff, in the rural areas of the Vale of Glamorgan. A challenge myself and members often discuss is how to protect and maintain our philosophy and culture whilst seeking to empower ‘the community to genuinely own the community’. I think some key elements include:

• Communication • Producing resources • Regular training and feedback sessions • Wider recovery events with all local groups • Local ‘boards’ supported by the main ‘hub’

Pain, medication and Pain, medication and Pain, medication and Pain, medication and addictionaddictionaddictionaddiction Prescription drug use and addiction, was for many years overlooked in the UK. Despite progress, the issue of prescription drug use and its relationship with pain / condition management can be complicated and hidden. Visiting The Las Vegas Recovery Centre, I met Dr Pohl who specialises in pain medication addiction.

We talked about some of the issues faced by people overcoming addiction to pain medication. Dr Pohl referred to the need for people to be supported and empowered to gain mastery over both their pain and their addiction. Long term pain can become a part of someone’s identity and its management can become all consuming. Separating pain management and addiction can be a complicated business, particularly as symptoms of addiction can include, justification, denial and hiding. Dr Pohl described the process of self-management techniques and breaking the cycle of addiction.


He also described how there are often additional challenges for family members to understand and develop boundaries while supporting their loves ones with pain medication addictions. Families often feel powerless over both their loved one’s pain and dependence on medications and feel a lot of guilt about seeing their loved one in pain. In the long run, this can exacerbate addiction cycles and the centre works with families to educate and support them. Pain medication addiction can also be a risk for people in recovery from other unrelated substances. It can be a difficult decision for someone to accept dependence-inducing medications for genuine medical reasons, for fear of ‘awakening the old beast’.

“When you are a former addict dealing with chronic pain, it is the most slippery of slopes. But aren’t addicts entitled to pain management? Just because we are in recovery, are we supposed to agree to excruciating agony without any aid? I was in hell for three to four months before I consented to pain medication. But the addict brain does funny things and early on, my husband began to see signs of dependence and abuse.” Amy Dresden, American Comedienne in recovery


Vermont Vermont Vermont Vermont RRRRecovery ecovery ecovery ecovery NNNNetwork etwork etwork etwork –––– Vermont StateVermont StateVermont StateVermont State Vermont has a network of 11 recovery centres which are all independently functioning recovery community organisations (RCO’s), in different stages of development & with their own nuances. They are connected together by an overarching network, the Vermont recovery network. The network itself is a RCO. More information can be found at www.vtrnetwork.org. Many of the centres are historically steeped in 12-step based recovery and the network is currently in a transitional stage to embrace ‘all paths to recovery’. This has resulted from a general culture shift in the understanding of recovery in the USA and due to receipt of State funding stipulating a wider recovery philosophy. It was really interesting to visit a range of centres and discuss different recovery philosophies, definitions and personal biases towards 12-step recovery. I spent most of my time in Vermont, with Mark Ames, Network Coordinator who was very welcoming, helpful… and a character!

Main topics of conversationMain topics of conversationMain topics of conversationMain topics of conversation What is What is What is What is ‘‘‘‘goodgoodgoodgood’’’’ recovery and how do you measure it? recovery and how do you measure it? recovery and how do you measure it? recovery and how do you measure it? Is it enough for someone to ‘simply’ stop drinking alcohol or using drugs (and is it possible to maintain this in the long term) without an accompanying process of psychological change and / or personal development? Some of Mark’s comments included:

• “Getting a grasp of the extent that drugs and alcohol has had on your life makes it much less likely you will return. Tools which help to give you clarity give you the underpinning for why you want to change.”

• “‘The work of recovery’ is needed to go alongside the relief of the physical symptoms of recovery.”

• “The task of recovery is to understand the true extent of the impact of your drinking / using and to build a life that doesn’t necessitate this anymore.”

‘Measuring recovery’ was a reoccurring topic on my fellowship and is discussed in more depth below. Recovery coachingRecovery coachingRecovery coachingRecovery coaching Recovery coaches can be the bed-rock of recovery peer-support services and mutual-aid organisations. Training and supporting people in recovery to support and train others to achieve lasting recovery is at the heart of recovery coaching.


Recovery coaches are essentially trained peer supporters / coaches who support people to find and continue their recovery journey. Here’s part of the Vermont Recovery Network definition:

‘Recovery Coaches see a person as being in recovery when they start considering life changes that undo the damage caused by alcohol and drug use. Coaches help people plan and make positive changes. They work with people experiencing problems with their use of drugs and alcohol, people who are already in recovery, and people who are concerned about someone else’s substance use. Recovery Coaches help people by asking searching questions. Then they help with making decisions and plans that will improve lives, one step at a time. Coaches help find the resources needed to reclaim lives derailed by addiction.’

‘Recovery Coaches help people by asking searching questions. Then they help with making decisions and plans that will improve lives, one step at a time. Coaches help find the resources needed to reclaim lives derailed by addiction.’ This may be in the community or within treatment services. Mark and I had many discussions about how to manage the recovery coach programme to ensure it operates effectively and healthily. Following on from the above conversations about ‘what is good recovery’, Mark shared the loose criteria upon which potential recovery coaches are selected. Criteria include:

• Giving back to the community • Altruistic activities • Abstinent from problematic use • Been through a psychological and / or spiritual process of change • Markers – either in time or stability

This is an on-going piece of work, in Vermont and the UK. RecognitionRecognitionRecognitionRecognition The Vermont Recovery Network is committed to advocating peer-based recovery support services and recently secured state funding to offer recovery coaches $35 stipend for each hour’s recovery support delivered in the recovery centres. This monetary recognition of the efficacy of recovery coaching is a major breakthrough in the delivery of peer based recovery support services. This stipend constitutes a % for two hour’s work for the coach and the remaining goes towards administrative costs of the recovery coach supervisor and recovery centre.


The MARS The MARS The MARS The MARS project project project project ---- New York CityNew York CityNew York CityNew York City MedicationMedicationMedicationMedication----assisted recoveryassisted recoveryassisted recoveryassisted recovery Medication assisted recovery is arguably one of the most contentious current issues in UK addictions treatment. There is much debate about the use of medications such as, methadone, subutex, antebuse and naltrexone. Resulting from a medicalised model of addiction and drug strategy focus on reducing the risk of harm of drugs to the individual and society, a ‘culture of prescribing’ has prevailed in the UK. The recent recovery movement has advocated for this to be addressed and for more holistic approaches to treatment, including abstinence to be offered in earnest. With regular stories of people being ‘stuck on a script and left by the wayside’, this is imperative. However, once again there is a need for balance and recognition of the role medication can play in an individual’s recovery journey when it is accompanied by holistic approaches to addressing the psycho-social-spiritual elements of the recovery journey. In the UK, the recovery movement is finding its feet and I think it’s important that we do not stigmatise or demonise the role that medication can play in some people’s journey at some point. There is a danger of an unnecessary polarisation of addiction treatment and recovery approaches between ‘harm reduction’ and ‘recovery’. The reality is that recovery is a unique journey for each individual and at different stages of that journey, different choices should be available. In the United States, which has been heavily based on a 12-step abstinence model for many years, the existence of medication assisted recovery (MAR) is increasingly a topic of conversation. There are a number of vocal recovery advocates who are raising awareness of MAR and advocating for the legitimacy and effectiveness of medication-assisted recovery. Walter Ginter, from the MARS Project is one of those advocates. He is also a role model for the efficacy of medication assisted recovery. The MARS Project by Walter Ginter, Programme DirThe MARS Project by Walter Ginter, Programme DirThe MARS Project by Walter Ginter, Programme DirThe MARS Project by Walter Ginter, Programme Directorectorectorector Our first priority at the MARS Project is to educate patients about opiate addiction, how medications work, and recovery. Many do not realize or have been told not to believe that opiate addiction is a chronic brain disease and not a symptom of a lack of character or moral fiber. Located in Bronx, New York, and launched in 2006 the Medication Assisted Recovery Support Project (MARS) is a collaborative endeavour of the National Alliance of Methadone Advocates (NAMA) and the Albert Einstein College of Medicine. The program offers recovery support services to patients in the outpatient methadone treatment program. These services are designed and delivered by recovering peers who have a unique understanding of the challenges and opportunities one encounters on the road to recovery. The services provided by MARS complement those provided in the treatment program, focusing on giving participants the tools they need to be more effective facilitators of their own recovery and affirming that they are, indeed, bona fide members of the recovery community, and not individuals who are, as a common myth has it, substituting one addiction for another.


During my time at The MARS Project, I had the opportunity to talk to Walter Ginter, Joyce Woods from NAMA (see below) and to attend peer groups ‘intro to medication assisted recovery’ and peer leader recovery coach academy training. Below are the main learning points from my time at MARS Addiction and medicationAddiction and medicationAddiction and medicationAddiction and medication----assisted recoveryassisted recoveryassisted recoveryassisted recovery “The biggest misunderstanding concerning methadone is really about opiate addiction and the failure to recognize it as a medical condition and to recognize methadone as a medication. When somebody breaks a leg, we don’t ask them, “Hey, were you skiing dangerously? Because if you were skiing dangerously and going too fast, we’re not going to treat you. When we deal with methadone, we deal with the perception of addiction as a self-inflicted condition and that such conditions do not deserve the best possible medical care. Opiate addiction has both medical and behavioural components. All chronic diseases have a behavioural component, and that’s what you’re dealing with—a chronic disease. The problem with the methadone community is we have too many people who think methadone is a magic bullet for that disease—that recovery involves nothing more than taking methadone. This view is reinforced by people who, with the best of intentions, proclaim, Methadone is recovery.” Methadone is not recovery. Recovery is recovery. Methadone is a pathway, a road, a tool. Recovery is a life and a particular way of living your life. Saying that methadone is recovery let’s people think that, “Hey, you go up to the counter there, and you drink a cup of medication, and that’s it. You’re in recovery.” And of course, that’s nonsense. Too many people in the methadone field learn that opiate dependence is a brain disorder, and they think that that’s all there is to it. But just like any other chronic medical condition, it has a behavioural component that involves how you live your life and the daily decisions you make. Perhaps the biggest misunderstanding about methadone involves the word “substitution.” Extensive damage has resulted from using the word “substitution” in reference to methadone treatment. That one phrase completely blurs the distinction between treatment and active addiction. If methadone is just a substitute, then there’s no difference or little difference between treatment and active addiction.” The medication assisted recovery approachThe medication assisted recovery approachThe medication assisted recovery approachThe medication assisted recovery approach In light of Walter’s words above, it is essential that medication assisted recovery is recognised as just that. A recovery process that it assisted by medication – not simply a medication that ‘cures’ addictive behaviour. This must involve:

• Recognition, understanding and validation of medication assisted recovery from the recovery community

• Recovery oriented methadone programmes and peer recovery services • Training for professionals in methadone programmes relating to methadone and methadone

maintenance • Education about addiction, medication and recovery for people seeking medication assisted

treatment and recovery pathways • Celebration of ALL pathways to recovery, including medication assisted recovery

Walter goes on to say,


“One of the things I would really like to see methadone programs do is make space available for recovery-focused activities. Even if it was just one room somewhere for peer initiated 12-step groups or whatever the patients wanted to do. It’s so important for patients to have contact with other people. In methadone clinics, we don’t get that. Most of us in recovery get it from going to 12-step meetings, but methadone patients are often ostracized from 12-step meetings. We have Methadone Anonymous, but Methadone Anonymous really only exists in the methadone programs.” Challenging stigma of medication assisted recovery: society, treatment and the recovery Challenging stigma of medication assisted recovery: society, treatment and the recovery Challenging stigma of medication assisted recovery: society, treatment and the recovery Challenging stigma of medication assisted recovery: society, treatment and the recovery community community community community There is little debate about the presence of stigma, misconceptions, myth and prejudice relating to medication assisted recovery. When questioned about the most effective strategies to challenge the misconceptions about opiate addiction and reduce the stigma related to medication-assisted treatment and recovery, Walter replied: “We have to get people out there to be seen. We need the Lisa Torreses. We need people to stand up and talk about it. I can remember doing these educational panels at various places and then telling the audience, “Some of us up here are methadone patients.” They always picked out the wrong person trying to guess the methadone patient. We were of course all methadone patients. We need people who wear a shirt and tie, dress well, and are articulate to stand up and say that they’re patients. The first strategy is that simple, which of course isn’t simple at all. Lisa Mojer Torres is a leading methadone recovery advocate in the States. In an interview with the eminent addiction and recovery research William L. White, Lisa explains her thoughts below: The most visible of the stereotypical methadone patients are people in government-subsidized methadone maintenance treatment programs in larger urban areas. These have evolved into a sort of “harm reduction” net, catching chronic opiate addicts who are mentally ill, poly-chemically addicted; and without resources, family/community integration or prospects (i.e., their addictions having burnt the bridges to a normal, healthy, independent, addiction-free life). Their use of methadone has been identified as the primary “cause” of their failure to thrive. Methadone is specific to treatment for a single class of drugs: the opiates (note, it is also used as analgesia to treat pain). It makes absolutely no sense to heap such high expectations upon a single medication (can you imagine expecting insulin to cure overeating?). The fact that patients suffer from active poly addictions or psychiatric disorders while in methadone treatment is not due to any defects in the medication/methadone hydrochloride. Methadone has limited scope and purpose; it is not, nor was it ever intended to be “a magic bullet” to cure all addiction, or even to cure all of the various behavioural elements of opiate addiction. I believe there is a clear distinction between patients who are in the earlier phases of methadone treatment from patients who have achieved pharmacologic stability and are in sustained recovery, no longer using illicit substances, etc. At this point, the medication’s functions change from one of “treatment” for primary active opiate addiction to that of supporting and sustaining recovery and relapse prevention. I believe that as the field of substance addiction treatment begins to shift in orientation from acute care to one which is consistent with our knowledge of substance addiction as a chronic disease, the shift in services will follow. There also needs to be a respect for and deference to the organized recovery community to determine the process and deliver the particular services for each client, allowing him or her to identify their individualized paths to recovery. Otherwise, as with the rest of the treatment field, recovery-oriented philosophies and services will be limited and referred to the current universe of established volunteer, peer-to-peer 12 step recovery meetings.


It is time that we nested methadone within a vibrant recovery culture and made sure that an array of comprehensive services are available for every patient who crosses the bridge from treatment into recovery through the nation’s methadone clinics. Myth: Myth: Myth: Myth: ‘‘‘‘Medication Assisted Recovery is simply substituting one addiction for anotherMedication Assisted Recovery is simply substituting one addiction for anotherMedication Assisted Recovery is simply substituting one addiction for anotherMedication Assisted Recovery is simply substituting one addiction for another’’’’ “If you are interested in recovery, you have to take the other step and deal with the behavioural aspect, in addition to methadone maintenance.” “We need to introduce the concept of recovery to patients as they are often not looking for recovery but are looking not to be ill. They need to be told they are a candidate for recovery, even if they are on methadone.” Myth: Myth: Myth: Myth: ‘‘‘‘TheyTheyTheyThey’’’’ll dish out methadone to anyonell dish out methadone to anyonell dish out methadone to anyonell dish out methadone to anyone’’’’ ‘Take home’ requirements at MARS:

• No recent drug use • Attends clinic • No serious behavioural problems • No criminal activity • Stable home environment and social relationships • Length of time in treatment • Assurance the take home will be safely stored • Judgement that the rehabilitative benefit will outweigh the risk of diversion (selling the

methadone to others) NAMA: National Alliance for Methadone AllianceNAMA: National Alliance for Methadone AllianceNAMA: National Alliance for Methadone AllianceNAMA: National Alliance for Methadone Alliance NAMA Recovery is an organization composed of medication assisted treatment patients and health care professionals that are supporters of quality opiate agonist treatment. We have thousands of members worldwide with a network of international affiliated organizations and chapters in many places in the United States. The primary objective of NAMA Recovery is to advocate for the patient in treatment by de-stigmatizing and empowering medication assisted treatment patients. First and foremost, NAMA Recovery confronts the negative stereotypes that impact on the self-esteem and worth of many medication assisted treatment patients with a powerful affirmation of pride and unity. I met Joyce Woods, a founding member of NAMA who is committed to advocacy, reducing stigma and prejudice, campaigning in politics and addressing employment issues for those in medication assisted recovery. Joyce works with Walter to educate peers in MARS about addiction, medication and recovery and to empower them to challenge misconceptions as they grow in their own recovery. Her comment, ‘’The one thing they should feel proud about they feel ashamed about” was a poignant message for me as I considered the impression the current debate and campaigns to change the prescribing approaches in the UK can give to those whose recovery is validated by the use of medications. The need for choice, balance and steering away from a ‘one size fits all’ approach to treatment and recovery is essential to not isolate and polarise sub-sections of the recovery community. Having said that a positive approach to prescribing and offering people the opportunity to reduce or cease medications, at the right time and in the right way, must also be a priority.


Following meetings with NIDA (The National Institute of Drug Abuse) in the States to discuss the need to training and certify methadone advocates, NAMA is now the authority for training and certifying people. This is an exciting step in raising awareness of MAR and empowering people to be proud of their recovery. NAMA is also linked to the British affiliation - The Alliance.


Exponents Exponents Exponents Exponents ---- New York CityNew York CityNew York CityNew York City Exponents is dedicated to improving the quality of life of individuals affected by drug addiction, incarceration and HIV/AIDS. Programs are designed to support successful life transitions through engagement in services which ignite hope and promote awareness. Activities gradually move individuals along a progressive path of life stabilization while fostering a sense of community and individual responsibility. Howard Josepher, the founder and president of Exponents, a minority led, community-based organization in New York City helping people struggling with substance abuse, HIV/AIDS and re-entry to the community after incarceration. Programs focus on the health and mental health needs of participants, providing self-management skills to prevent chronic conditions from becoming more acute and requiring a higher and more expensive level of care. The organization offers an array of services offered through 11 different programs including out-patient drug treatment; transition planning from prison and re-entry services; HIV testing and counselling; and a recovery and wellness support centre. In 1988, Mr Josepher created ARRIVE, one of the first HIV/AIDS programs in the country for injecting drug users. The program, which began in a church basement on the Lower East Side of Manhattan, pioneered the use of harm reduction practices and utilization of peer educators. As of April 2011, the ARRIVE program has more than 9,500 graduates, all of whom attended voluntarily. The ARRIVE model has been recognized by the Substance Abuse and Mental Health Services (SAMHSA) as an evidence based, best practices model for working with individuals in the criminal justice system. Exponents run a range of programmes, more details of which can be found at www.exponents.org. Harm reduction and recovery Harm reduction and recovery Harm reduction and recovery Harm reduction and recovery –––– whatwhatwhatwhat’’’’s the big debate?s the big debate?s the big debate?s the big debate? As an advocate of a unified recovery movement and recovery oriented integrated treatment system, I was pleased to visit a ‘harm reduction’ service that sees no distinction between the philosophies of ‘harm reduction’ and ‘recovery’. A pragmatic, real-world, person-centred approach recognises that:

• People need to be alive to recover • Behaviour change is a process • Risky behaviours reduce as self-care and life satisfaction increases • Peer networks are powerful • People respond to direction and care • People need activity – we need something to be busy doing

I was impressed by the pragmatic and hopeful approach to arguably one of the ‘most chaotic client groups’ (I hate talking about people in that way): those individuals affected by drug addiction, imprisonment and HIV/AIDS and other BBVs (Blood borne viruses) such as Hepatitis C. the programmes I had the opportunity to observe were upbeat, caring and challenging. Service users are told about their power, potential and positive attributes, whilst also putting them in social learning environments with new social norms, including:

• Speak with integrity • Don’t take anything personally • Don’t make assumptions • Always do your best • ‘Keep showing up’

‘‘‘‘The beast withinThe beast withinThe beast withinThe beast within’’’’: the link between addiction and depression: the link between addiction and depression: the link between addiction and depression: the link between addiction and depression


‘The beast within’ is a teaching that occurs throughout Exponents, written and delivered by Howie Josepher, Exponents Founder. It is a psycho-education programme that assists people to determine and master, ‘the beast within’. The beast within is the negative ‘troubled mind’ (unhealthy, troubled thinking), that is the root cause of negative addictive behaviour. The troubled mind and addictive behaviour is depression. To overcome this depression, people need to recognise the link between addiction and depression and reframe their beliefs and frame of references that cause pain, depression and the cycle of self-medication with drugs and alcohol, to master ‘the beast within’. Through teaching ‘mindfulness’ skills individuals are given the tools to be able to ‘step back’ and observe their thoughts, to see them in an objective light and make decisions based upon these ‘reality checks’ as opposed to emotional reactions and learned patterns of behaviour. Participants are taught a kind of ‘higher consciousness’ through mindfulness techniques. Mindfulness (also translated as awareness) is a spiritual faculty that is considered to be of great importance in the path to enlightenment according to the teaching of the Buddha. In more recent times, several definitions of mindfulness have been used in modern psychology. According to various prominent psychological definitions, Mindfulness refers to a psychological quality that involves: “Bringing one’s complete attention to the present experience on a moment-to-moment basis” (Marlatt & Kristeller, 1999). “Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994). ‘The Beast within’ course is a series of cognitive sessions focusing on acknowledging, ‘the beast within’, positive thinking, stress control, emotions, depression and self-management skills. More information about ‘The Beast within’ can be found in a thirty minute film on the Exponents website www.exponents.org What is recovery at Exponents?What is recovery at Exponents?What is recovery at Exponents?What is recovery at Exponents? Shortly before I left Exponents, I asked my regular questions, ‘What is Recovery?’ Some of the answers I received included: Self-acceptance, pro-activity, a process of change that occurs over time, accountability for what your recovery is, ownership, growth, social learning and responsible behaviour. Interesting how none of these descriptions mention drugs of alcohol! Food for thought…


The Fix and Loft 107 The Fix and Loft 107 The Fix and Loft 107 The Fix and Loft 107 ---- New York CityNew York CityNew York CityNew York City During my online research for the Fellowship, I came across the online magazine, ‘The Fix’. The Fix (www.thefix.com) is the world's leading website about addiction and recovery, featuring a daily mix of news, investigative reports, celebrity interviews, and articles on health, science and sober living—written by some of the top writers in the country. I had the opportunity to meet Joe Shrank, The Fix Founder and Treatment Specialist. Although a ‘flying visit’ during a New York City heat wave, a short discussion about ‘all things recovery’ left me with some longer term topics to ponder. The Fix The Fix The Fix The Fix –––– Recovery stories and public interestRecovery stories and public interestRecovery stories and public interestRecovery stories and public interest As one of Recovery Cymru’s aims is to increase public awareness of recovery and to challenge stigma, stereotyping and prejudice, I thought the concept of ‘The Fix’ an important one. They have created a credible online magazine, which marries together journalistic professionalism, current news of typical public interest with other factual and personal story articles raising awareness of the impact of drug, alcohol and other addictions. ‘‘‘‘Being thereBeing thereBeing thereBeing there’’’’ As a treatment specialist, Joe also discussed how he recently ‘chaperoned’ a well-known rock drummer, who is in recovery, on a world tour. He described how this guy’s history had taught him that a) going on tour always threatened his recovery and b) he loved his music and wanted to tour! As a result, Joe was able to buddy him throughout the tour, offering peer support, advice and guidance to encourage him to make wise decisions. As Joe succinctly put it, “You can tell someone to leave after the gig and go to a meeting’ til you’re blue in the face, but it’s no substitute for actually being there and going with them.’ I thought this sums up a lot of what peer support is about, simply being there with someone, helping them not to feel the ‘odd one out’ for not partying with drugs and alcohol, having fun and being a friend. I think this is particularly relevant in the UK where there is a myth that ‘everyone’ drinks, ‘everyone’ goes to the pub on a Saturday night, and ‘everyone’ drinks to watch the rugby and so on. It may appear that way (and believe me, it can look that way on St Marys Street, Cardiff on a Saturday night) but the reality is, recovery is alive and well in the UK, we just need to make it more visible. Interventions Lastly, we discussed the regular American act of ‘staging an intervention’ for people who are in ‘active addiction’. An intervention is an orchestrated attempt by one, or often many, people (usually family and friends) to get someone to seek professional help with an addiction. Interventions are either direct, typically involving a confrontational meeting with the alcohol or other drug dependent person (the most typical type of intervention) or indirect, involving work with a co-dependent family to encourage them to be more effective in helping the addicted individual. (American Journal of Drug and Alcohol Abuse). The use of interventions originated in 1960s with Dr. Vernon Johnson. The Johnson Model was subsequently taught years later at the Johnson Institute. In my experience, aside from informal interventions (for example when family members try to encourage or coerce people to seek treatment), professional interventions are uncommon in the UK. This is in stark contrast to the American model where they are so common they are regularly screened on the US docu-drama ‘Intervention’. Joe described a typical intervention process:

• A family or friendship group rings a professional interventionist and asks someone to facilitate an ‘intervention’


• The person drinking or using is not forewarned – the element of surprise seems to be a core attribute

• Family members are encouraged and helped to describe the impact of the persons using and drinking on them and the consequences that will result if they do not change

• Undertaken with love, concern and a non-judgemental attitude, it is however a coercive process with an agenda to get the person to agree to enter treatment.

Much of UK treatment methodology has in recent decades been based upon a belief in the Prochaska and Transtheoretical Model of Behaviour Change Diclemente (developed in the 1980s and famously described in the book Prochaska, JO; Norcross, JC; DiClemente, CC. Changing for good: the revolutionary program that explains the six stages of change and teaches you how to free yourself from bad habits. New York: W. Morrow; 1994.). The model assesses an individual's readiness to act on a new healthier behaviour, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance.

In summary, it views change as a "process involving progress through a series of stages:”

• Precontemplation (Not Ready)-"People are not intending to take action in the foreseeable future, and can be unaware that their behaviour is problematic"

• Contemplation (Getting Ready) - "People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions"

• Preparation (Ready) - "People are intending to take action in the immediate future, and may begin taking small steps toward behaviour change" http://en.wikipedia.org/wiki/Transtheoretical_model - cite_note-27

• Action – "People have made specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours"

• Maintenance – "People have been able to sustain action for a while and are working to prevent relapse"

• Termination – "Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping”

In addition, the researchers conceptualized "relapse" (recycling) which is not a stage in itself but rather the "return from Action or Maintenance to an earlier stage." (Prochaska, JO; Velicer, WF,1997) In light of this theoretical underpinning of many models of addiction (and models of recovery), I wondered if the UK would embrace the idea of staging an intervention and where this would fit on the ‘cycle of change’.


Road Recovery Road Recovery Road Recovery Road Recovery ---- New York CityNew York CityNew York CityNew York City Suggested by Joe Shrank from The Fix, I was encouraged to meet Gene Bowen who set up and runs ‘Road Recovery’. Gene is an interesting man with personal experience of recovery, a strong passion for guiding young people away from drug and alcohol use and other destructive behavioural patterns, as well as a great ability to harness the power of the music industry which is arguably renowned for drug and alcohol use – as well as positive stories of recovery… think, Gene Bowen, Slash, Nikki Sixx, Elton John, David Bowie… the list goes on. Here’s a bit more about Gene: “In February, 1992, Gene Bowen was faced with the reality of imminent death from an out-of-control habit. For ten years, he had been a tour manager for a variety of artists. Since 1982, Gene’s daily routine included obtaining drugs not only for himself, but for many of the international artists and road crews with whom he worked and toured. Ironically, he was also responsible for helping particular artists stay "clean." With the help of family, friends and music industry colleagues, Gene was one of the lucky ones who embraced recovery. Understanding how lucky he was to survive, Gene set out to build an organization to educate young people about addiction and other adversities in hopes of helping them find their way towards a healthy and happy future. He looked to publicize the many strengths and resources available from the music/entertainment industry and the mental health field. With the support of Sony Music Entertainment and DreamWorks Records, as well as mental health/substance abuse specialists, entertainment industry professionals who faced their own personal adversities, the ROAD RECOVERY FOUNDATION, a non-profit (501c) organization, was established in February 1998.” Road Recovery is dedicated to helping young people battle addiction and other adversities by harnessing the influence of entertainment industry professionals who have confronted similar crises and now wish to share their experience, knowledge, and resources. With support from the mental health field, ROAD RECOVERY provides hands-on mentorship training, educational/performance workshops, peer-support networking, and “all access” to real-life opportunities by collaborating with young people to create and present live-concert events. ROAD RECOVERY empowers young people of all backgrounds to face their struggles and helps them develop comprehensive life skills, guided by professionals and supported by a community of like-minded peers. It’s reassuring how many recovery projects have similar beliefs or ‘veins’ of thought running through them, whilst still maintaining their own flavour and way of doing things. When I read the beliefs of Road Recovery, each one had something in common with the beliefs underpinning Recovery Cymru. Read below to see the similarities (Recovery Cymru in purple). Road Recovery beliefs:

• That not everyone who drinks is an alcoholic and not everyone who dabbles with drugs becomes addicted. But for some, it takes just one time – one experiment following another, leading to a painful and often catastrophic end.

People’s problems with drugs and alcohol differ and each recovery journey is individual. We are not all the same but we all have commonalities we can share and learn from

• That knowledge, shared personal experiences, open dialogue, interdependence and the power of positive example has a profound impact on others (and often, ourselves).

The power of shared experience and understanding


• There is no such thing as a quick fix. Our programs are built on establishing relationships and trust, over time.

Recovery is a journey

• That through action, change is possible. Our programs are action-based, action-driven. Recovery through activity

• That everyone has something to learn . . . and, something to teach. We believe in mentorship and sharing personal experiences, to help young people "connect the dots" towards a healthy future.

Everyone has something to give, as well as receive

• In crisis prevention, while also providing avenues of care for those who seek help from their active addiction or adversity.

Being there when things go wrong Recovery Cymru runs a peer-led music group called ‘Recovery Jam’, in partnership with Inroads Drugs Project, a local harm reduction agency in Cardiff (who says recovery and harm reduction projects are polarised?! See above ‘Exponents’. Learning more about how Road Recovery harness and nurture creativity to heal, teach and inspire young people in New York City gave me more ideas for the development of Recovery Jam. I look forward to working with Inroads and the Recovery Jam group to explore the many possibilities. I believe music is powerful in recovery for a number of reasons:

• Studies have shown that individuals with or in recovery from addictions tend to score highly on creativity

• Music is an expressive art that all people can get involved in, by playing, listening, organising events and so on

• Many people in recovery believe they need to steer away from hobbies/passions which may have been heavily involved in their problematic behaviour. I believe, with the support and company of others who support recovery, people can learn to enjoy these hobbies/passions without jeopardising their recovery.

• Music is a great way of raising awareness • Music is cool! Young people are attracted and it’s a way of spreading the message you can

have fun without being drunk or under the influence. I had to leave you on my favourite quote from Gene Bowen. While talking about Road Recovery and the exciting projects they are involved in, he passionately described how the whole project is, “An ‘F’- you to people who say being sober is boring.” I’ll leave out the hand gestures!


The Loyola Recovery Foundation The Loyola Recovery Foundation The Loyola Recovery Foundation The Loyola Recovery Foundation –––– Albany, New York StateAlbany, New York StateAlbany, New York StateAlbany, New York State

After a ten day stretch in the New York City heat wave, I was pleased to get out of the City and travel upstate to visit The Loyola Recovery Foundation. The Foundation offers, ‘a pathway of hope for veterans with addiction’ and I had the privilege of meeting Christopher R. Wilkins and colleagues, who were extremely hospitable hosts and who helped me to think about the organisational development of an emerging recovery organisation.

It was hugely helpful to receive the benefit of their business acumen and vast experience in many of the core aims of Recovery Cymru. As I described the vision of Recovery Cymru and the vast amount of ideas I was buzzing with, in addition to the many projects, ‘on the boil’ back home, they encouraged me they had some caring and direct words of wisdom! They were encouraging of the passion and commitment we have built in recovery Cymru but advised me to further develop my strategic and business skills to enable me to plan effectively to support the on-going vision of Recovery Cymru in a measured and sustainable way. ‘It’s great being a bottle of pop but what happens when you lose your fizz’ (i.e. don’t burn out!). Chris encouraged me to focus in on a measurable business plan, for the next 1, 3 and 5 years, directing energies into no more than three priorities. We established that our main priorities for Recovery Cymru are:

1. Direct community 2. Advocacy 3. Organisational development

Direct community refers to the development of the recovery community, including:

• Self-help, support groups and meaningful activities • Social networks • Maintaining our philosophy and ethos as we grow • Welcoming new people and their families, nurturing members and volunteer programmes to

run parts of the community and accommodating growing numbers • Developing and establishing our recovery coaching, recovery champion and telephone

recovery support programmes • Developing social enterprises, offering opportunities to people who are often disadvantaged

in the workplace Advocacy refers to our aims to:

• Give recovering people, their families and advocates a voice • Reduce stigma, discrimination and prejudice of people with and in recovery from drug and

alcohol problems • Work alongside colleagues in drug and alcohol treatment services to advise, consult and

train in the delivery of the recovery model


• Join with the wider recovery movement to influence policy and commissioning • Work with employers to support employees and employers to positively manage drug and

alcohol problems in the workplace Organisational development

• As a young organisation, developing systems, procedures, business plans and sustainable financial models while maintaining our ethos, values and unique ‘flat hierarchy’. Often more simple on paper than in real life but well worth the effort!


The McShin Recovery Foundation The McShin Recovery Foundation The McShin Recovery Foundation The McShin Recovery Foundation –––– Richmond, VirginiaRichmond, VirginiaRichmond, VirginiaRichmond, Virginia

A long journey South led me to Richmond, Virginia to meet John Shinholser and Carol McDaid (the two namesakes of the ‘McShin’ Recovery Foundation). The experience was unforgettable! The McShin Foundation is a Recovery Community Organization (RCO). They have an authentic peer-oriented social model program. They believe the first thirty days after intake is the most critical period for recovery and it is at this time we make our greatest inroads in building our recovery foundation. They seek to implement rapid entry into involvement with available pathways to long term successful recovery and begin to instil a genuine desire in the individual to chase their recovery, in part by learning from others in recovery. Through authentic peer-oriented guidance, the individual has a good understanding of what it takes to recover on a daily basis. John Shinholser serves as the President of The McShin Foundation, which was founded by John and Carol who have dedicated their lives to helping individuals and families in or seeking recovery from addiction. The McShin Foundation operates on their belief that by helping others find and sustain recovery, they can better sustain their own recovery. Carol is an eminent lobbyist in Washington DC and a board member of FAVOR (Faces and Voices of Recovery), a national advocacy organisation (see more below). Putting me up in their home, John and Carol introduced me to their recovery centre, took me sightseeing, to my first recovery pool party/hog fest, an Alcoholics Anonymous meeting in a local prison/hog fest and even took me for some much needed pampering to get my nails done! Many hours of talking, pondering and philosophising, with an equal amount of laughing and eating, left me with an impression of the McShin Centre that is hard to put into words. There was something about the very warm, ‘real’ atmosphere that I felt helped people to feel they could genuinely be themselves while learning through 24-hour social interactions with others in different stages in recovery. I was particularly struck by the network of recovery houses McShin has developed in and around Richmond which was a reaction to a direct need for safe, affordable houses for people in early recovery. Residents can then ‘graduate’ to become house supervisors, which is part of their core peer model, meaning people are always around others who have walked a similar path to themselves. In keeping with this, McShin run regular social and fundraising events, which raise awareness and funds, as well as giving people positive ways to spend their time on the weekends. This reminded me of the events bonanza we ran for Recovery Cymru in 2010. In more recent times we have been distracted by seeking and securing a building as our hub and as a result our larger events have reduced. Attending a McShin BBQ and pool party reminded me of the fun and positivity of these events. Watch this space Cardiff! We are now planning a 24-hour cycle, 5 a side football tournament and a BBQ! I was also struck by the age range of people accessing the McShin peer services. Many of them were younger (or am I getting older?!) than the members we currently have in Recovery Cymru. Although


I was generally struck throughout my travel by how many younger people were ‘getting in’ to recovery, McShin members seemed younger still. I was definitely challenged in my (wrong) assumptions that people in their teens and early twenties are less likely to seek a recovery centre. It’s certainly made me think about how we reach out to younger members locally. A few months later, it was a pleasure to welcome John and Carol to Cardiff, Wales in September 2012 where they were talking at a recovery conference and joined us on the First Welsh Recovery Walk, which Recovery Cymru had the privilege of organising in partnership with a number of Cardiff organisations. It was a truly special experience and is part of a longer term plan to put a Face and a Voice on Recovery in Wales!

Some pictures from the First Welsh Recovery Walk, held in Cardiff on 11th September 2011. More details can be found at www.recoverycymru.org.uk/firstwelshrecoverywalk.


Philadelphia's Dept. of Behavioural Health and Intellectual Disability Philadelphia's Dept. of Behavioural Health and Intellectual Disability Philadelphia's Dept. of Behavioural Health and Intellectual Disability Philadelphia's Dept. of Behavioural Health and Intellectual Disability Services (DBHIDS)Services (DBHIDS)Services (DBHIDS)Services (DBHIDS) Another long journey took me from Richmond, Virginia to Philadelphia, the home of the famous ‘Rocky’ steps famed in the Sylvester Stallone Rocky movie and the increasingly famous ‘Philadelphia Department of Behavioural Health and Intellectual Disability’ (DBHIDS). I was excited about visiting the ‘home’ of recovery-system transformation as I have been reading about their work for years. DBHIDS is famed for their ‘transformational system design’ approach, a long-term, collaborative effort that saw partners from addiction, mental health, homeless, criminal justice, family services and the wider recovery community work together to produce a full system re-design for the benefit and long-term recovery of people accessing services in Philadelphia. I am indebted to Brooke Feldman who coordinated a jam-packed schedule over four days, giving me the opportunity to meet people in recovery, service providers, managers, commissioners and policy-makers involved in designing and delivering recovery-oriented services and systems. We covered:

• System transformation • Community mobilisation • Service provision: addiction, mental health, criminal justice

In such a busy schedule, it would be impossible to cover everything I learned during my time in Philadelphia so I have picked out the main points of interest, particularly those that relate to my work in Wales.

Recovery Idol – a spin on ‘Pop idol’. Another fun, enaging recovery communty event in Philadelphia.

The delightful Brooke Feldman and Bethan Bartholomew (Recovery Cymru trustee)

System transformation, PhiladelphiaSystem transformation, PhiladelphiaSystem transformation, PhiladelphiaSystem transformation, Philadelphia----stylestylestylestyle Key ingredients:

1. Recovery vision and values 2. High performing collaborations and partnerships 3. Committed transformation champions 4. Strong community linkages 5. Targeted recovery focused interventions 6. Integrated behavioural health services


Practice guidelines 1. Aligning concepts: changing the way we think 2. Aligning practice: changing how we use language and practices at all levels, implementing

values based change 3. Aligning context: changing regulatory environment, policies and procedures, community

supports The practice guidelines framework includes: Ten core values that have guided the development of transformation principles and strategies and will continue to guide the implementation process:

• Strength-based approaches that promote hope • Community inclusion, partnership and collaboration • Person and family-directed approaches • Family inclusion and leadership • Peer culture, support and leadership • Person-first (culturally competent) approaches • Trauma-informed approaches • Holistic approaches towards care • Care for the needs and safety of children and adolescents • Partnership and transparency

Four service domains in which the strategies are carried out:

• Assertive outreach and initial engagement • Screening, assessment, service planning and delivery • Continuing support and early re-intervention • Community connection and mobilisation

Seven system goals that are concrete, action-oriented social that organise and focus the strategies:

• Integrate behavioural health, primary care and ancillary support services • Create an atmosphere that promotes strength, recovery and resilience • Develop inclusive, collaborative service teams and processes • Provide services, training and supervisions that support recovery and resilience • Provide individualised services to identify and address barriers • Promote successful outcomes through empirically supported approaches • Support recovery and resilience through evaluation and quality

They approached the re-design by involving all partners at all stages, engaging them through workshops and consultations, offering training, incentivising good practice and changing commissioning structures to provide ‘leverage’ to reward good practice and highlight areas of concern. Partners were given time and space to reflect on the change process, giving every opportunity to ‘get on board’. The system transformation learning was especially relevant to me as there are a number of system reviews and re-design projects currently being undertaken in parts of Wales. Many of these are focussing on enhancing people’s access to treatment, integrating services and improving options upon exit. This is no easy task! A number of additional key learning points regarding system transformation have stayed with me:

• Think long term – seven years minimum • Changing culture, beliefs and territorial working patterns is the major task


• System transformation must be driven from the top down (leverage, direction) AND the bottom-up (harnessing the power of the recovering community and advocates)

• Identify your allies (those who share your vision), followers (those who will jump on board when they see its benefits and that it’s not a threat) and resistors (says it all)… and communicate with them in that order!

• System change needs changes in commissioning and policy The model is based on evidence-based practice and research. Mobilising the recovery community Mobilising the recovery community Mobilising the recovery community Mobilising the recovery community –––– visiting Pvisiting Pvisiting Pvisiting PRORORORO----ACTACTACTACT Pennsylvania Recovery Organization Achieving Community Together (PRO-ACT), a grassroots recovery support organisation that mobilises groups of recovering people via their recovery centres and advocacy initiatives. They are instrumental in organising Recovery Walks and were very supportive of the First Welsh Recovery Walk, asking us to send them a video link so they could play it at their next walk! Bev Harbele was a great host, discussing the growth of the recovery movement in Philadelphia and giving lots of ideas for how we can promote its growth in Wales and the UK. Her top tips for a strategy for all recovery focused advocacy and recovery centre development were:

• Engage • Educate • Activate • support

In this way, the community genuinely takes ownership over the values and issues that are relevant to them, ensuring the movement is genuine and sustainable.

Thinking about advocacy, I was particularly impressed by the Philadelphia mural programme which sought to involve members of the community (particularly in deprived areas) to get involved in designing and painting large murals on the walls of buildings. The aim was to build community connectedness and pride in their local areas. The results were outstanding, as this picture shows! What struck me as we visited a few murals in the City was the lack of graffiti or vandalism. The community owned them and looked after them with pride. An idea for Cardiff?!

North East Treatment Centres: Service reNorth East Treatment Centres: Service reNorth East Treatment Centres: Service reNorth East Treatment Centres: Service re----design and Consumer Councilsdesign and Consumer Councilsdesign and Consumer Councilsdesign and Consumer Councils An innovative and genuine response to involving clients (consumers) into the design, planning and delivery of addiction services, in the North East Treatment Centres (NET) was the development of ‘Consumer Councils’. A fundamental element of the recovery model is the altered nature of the service relationship. In the transition from the acute care to the recovery management model, service relationships shift from ones that are hierarchical, professionally-directed, transient and highly commercialised to relationships that are reciprocal, client-directed and potentially time-sustained. In this latter model, clients are involved at all levels of decision-making within the service system, and the addiction professional shifts from the role of an expert who dictates the service process to an ally and


consultant to each client in the long-term recovery process. This is the ‘partnership’ model. (Evans, Lamb et al. 2002). Following participation on DBHIDS recovery training, NET committed to develop more recovery focused service provision in their treatment services in Philadelphia, which unfolded in five overlapping steps:

1. Re-educating everyone in the NET system toward a recovery management orientation 2. Re-organising leadership roles and functions 3. Using training and clinical supervision to help staff redefine their roles 4. Merging fragmented and separate program services into an interconnected continuum of

care by cross-staffing at all sites and services with a unified team of managers and clinical staff

5. Creating a Consumer Council to drive NET’s organisational transformational process The NET Consumer Council (CC) was created in August 2006 to provide representation and support for all service consumers at NET. The CC is led by officers who serve 3 month terms, who are elected by consumers. Meetings are held weekly and following consumer-led focus groups, four committees were created:

1. The treatment committee, which focuses on promoting ‘responsible concern’, coordinating a Recovery recognition Day and retaining members.

2. The Clubhouse committee, which focuses on the consumer’s life outside NET 3. The advocacy board, which addresses consumer feedback, suggestions and grievances 4. The Advisory board, which provides guidance to the CC and is made up of NET alumni, NET

staff and recovery community representatives. Out of the CC, a peer mentor program, community living programme, volunteer programme, newsletter and monthly recovery recognition day for consumers participating in or completing treatment have evolved. A consumer-run recovery centre has also been developed. What an example of what engaging, educating, activating and supporting groups of recovering people can do! In the UK we have a Service User Movement which has grown rapidly in the last five years. I would like to share some of the learning from NET to encourage the movement to be empowered to take it to ‘the next level’.

Me at the Rocky steps: I actually ran up them the following day… honestly!

The power of the recovery community

Celebrating achievement


A big thank you to all the service providers and participants I met at:A big thank you to all the service providers and participants I met at:A big thank you to all the service providers and participants I met at:A big thank you to all the service providers and participants I met at: • PRO-ACT (Recovery centre and advocacy) • Community Living Room (Mental Health) • New Pathway Project (Homeless and crisis team) • Interim House (Female residential) • Wedge REC (Mental Health) • NET (Addiction services and consumer council)


Connecticut Community for Addiction Recovery Connecticut Community for Addiction Recovery Connecticut Community for Addiction Recovery Connecticut Community for Addiction Recovery –––– ConnecticutConnecticutConnecticutConnecticut My last stop was Connecticut where I had the pleasure of visiting CCAR. The Connecticut Community for Addiction Recovery (CCAR) organizes the recovery community (people in recovery, family members, friends and allies) to: 1) Put a face on recovery and, 2) Provide recovery support services. By promoting recovery from alcohol and other drug addiction through advocacy, education and service, CCAR strives to end discrimination surrounding addiction and recovery, open new doors and remove barriers to recovery, maintain and sustain recovery regardless of the pathway, all the while ensuring that all people in recovery, and people seeking recovery, are treated with dignity and respect.

I visited the Hartford and Bridgeport community centres and was particularly struck by CCAR’s Volunteer programme and Telephone recovery support service. CCAR runs on a huge volunteering model, with a small number of paid staff organising the infrastructure of the organisation whilst peers, members and family members run the recovery support. This contributes to the individual’s recovery journey, whilst also ensuring the longevity and genuine community-focus of CCAR. The telephone recovery support service is a State-wide, funded programme which offers people the opportunity for a weekly, monthly or infrequent recovery support ‘check-in’ via telephone. The programme is highly organised administratively and is run entirely by volunteers. It was really motivational for me because this is entirely in tune with the vision of Recovery Cymru, exemplified by the fact that we have a ‘baby’ version of both of these programmes and seeing how they have developed into long-term programmes of genuinely peer-run recovery support services in CCAR made me want to get home and continue developing our ideas! Our volunteer programme has been growing continuously since we officially launched it in October 2011 and we continue to receive positive feedback about the text messaging network we run. We are looking forward to taking this to the next stage and are particularly excited about launching it in the Vale of Glamorgan which is a much more rural area than Cardiff.


Main FindingsMain FindingsMain FindingsMain Findings and Reflectionsand Reflectionsand Reflectionsand Reflections Recovery PhilosophyRecovery PhilosophyRecovery PhilosophyRecovery Philosophy I don’t think it’s an over-estimation to say that historically, most widespread treatment in America has been rooted in a disease model of addiction and 12-step based treatment programmes. The USA is the home of Alcoholics Anonymous (AA) and most of the recovery language until recent years has been based upon the 12-steps. Alcoholics Anonymous (AA), the first twelve-step fellowship, was founded in 1935 by Bill Wilson and Dr. Bob Smith, known to AA members as "Bill W." and "Dr. Bob", in Akron, Ohio. A Twelve-Step Program is a set of guiding principles (accepted by members as 'spiritual principles,' based on the approved literature) outlining a course of action for recovery from addiction http://en.wiktionary.org/wiki/addiction, compulsion, or other behavioural problems. Originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism, the Twelve Steps were first published in the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism in 1939. The method was then adapted and became the foundation of other twelve-step programs. As summarized by the American Psychological Association, the process involves the following:

• admitting that one cannot control one's addiction or compulsion; • recognizing a higher power that can give strength; • examining past errors with the help of a sponsor (experienced member); • making amends for these errors; • learning to live a new life with a new code of behaviour; • Helping others who suffer from the same addictions or compulsions.

These are the original Twelve Steps as published by Alcoholics Anonymous:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure

them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 11. Sought through prayer and meditation to improve our conscious contact with God as we

understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

There is no doubt that the 12-step approach is one of, if not the, most widespread peer-led, community based approaches to addiction recovery in the world, with groups running on every continent. However, there has been much debate and anecdotal resistance to 12-step recovery in more recent years, often due to a lack of understanding and the seeming lack of peer-led recovery self-


management programmes in the community for substance misuse problems. ‘No one size fits all’ and it is important for the recovery community to be a ‘big tent’ that recognises, celebrates and shares all routes to recovery. This will help the recovery movement to grow and will empower people to find the right approach for them. As such, in the UK, I think we need to be mindful to embrace, nurture and network together all peer-led recovery support approaches, joining up to form this ‘big tent’ and validating all philosophies and models. As I travelled around the USA, it became apparent how historically steeped in 12-step recovery the recovery community was. I did however, meet many people and projects committed to embracing ‘all paths to recovery’, including non-abstinence based recovery and long term medication assisted recovery. This was in many ways challenging the status quo and although I feel there may be teething problems, it will lead to real change over time. I hope this results in a broadening of the recovery community in the UK. Recovery coachingRecovery coachingRecovery coachingRecovery coaching The recovery coach is a non-professional service role. Persons serving as recovery coaches, rather than being legitimized through traditionally acquired education credentials, draw their legitimacy from experiential knowledge and experiential expertise (Borkman, 1976). Experiential knowledge is information acquired about addiction recovery through the process of one’s one recovery or being with others through the recovery process. Experiential expertise requires the ability to transform this knowledge into the skill of helping others to achieve and sustain recovery. Many people have acquired experiential knowledge about recovery, but only those who have the added dimension of experiential expertise are ideal candidates for the role of recovery coach. The dual credentials of experiential knowledge and experiential expertise are bestowed by local communities of recovery to those who have offered sustained living proof of their expertise as a recovery guide (White & Sanders, 2004). In the current worlds of addiction treatment and addiction recovery, a new role is emerging to bridge the chasm between brief professional treatment in an institution setting and sustainable recovery within each client’s natural environment, i.e. within the community. In the UK, an emerging roles of recovery coaches (peer mentors, buddies) and recovery champions (a face and a voice of the recovery community, based within treatment services). Recovery Cymru is involved in the development of both roles in Wales. This is exciting and has developed from a need and passion within the recovery community to perform these functions for the benefit of existing and future members. However, it, like most things worthwhile in life, is not simple! This excerpt from William L White in 2006 arguably described where we are in the UK now: “The recent growth in peer-based recovery support services as an adjunct and alternative to addiction treatment has created heightened ambiguity about the demarcation of responsibilities across three roles: 1) voluntary service roles with communities of recovery, e.g., the role of the sponsor within Twelve Step programs, 2) clinically-focused addiction treatment specialists (e.g., certified addiction counsellors, psychiatrists, psychologists and social workers), and 3) paid and volunteer recovery support specialists (e.g., recovery coaches, personal Recovery assistants) working within addiction treatment institutions or freestanding recovery advocacy/support organizations. Recovery coaching is at a frontier stage. The role lacks consistent definition and prerequisites across the country. There are potential conflicts with other service roles and voiced concerns about harm that could come to recipients of recovery support services due to incompetence or personal impairment. Orientation, training and supervision protocols are lacking. In short, the role of recovery coach is plagued by the same issues that faced an emerging profession of addiction counselling thirty-five years ago.”


As a result, it was a real benefit for me to be able to see for myself the recovery coach programmes in the Vermont Recovery Network, The MARS project, New York, The McShin Foundation, Virginia and CCAR in Connecticut. The main points I took home with me were: I need to think about and then describe how the Recovery Cymru recovery coach programme can support self-defined and all pathways to recovery philosophy.

• Role definition needs to be widely recognised and understood • Community-defined and realistic suitability and selection criteria for prospective coaches in

critical • Training, support and supervision for coaches is essential • Managing risk needs to be put into the context of the benefits • An organisational infrastructure is needed to support the recovery coach programme

These elements are equally critical for the development of the Recovery Champion role. This is currently under development as part of a system re-design project in Cardiff and the Vale of Glamorgan. Measuring recoveryMeasuring recoveryMeasuring recoveryMeasuring recovery What are appropriate outcomes (indicators & measures) for recovery focused treatment, peer-based recovery support communities and the wider activities of a Recovery community organisation (RCO)? This is an on-going topic of consideration and advocacy, both in the UK and the States (and I’m sure further afield). It’s also a really important one. What struck me about the discussions I’ve had in both the UK and USA is that many of us are asking the same questions and in many instances advocating for outcome indicators that better reflect both the treatment journey and recovery journey individuals experience. These may well differ or have particular nuances depending on whether we’re talking about treatment or community-based peer-based recovery support services but there are also likely to be many similarities. This focus within the recovery movement may provide an opportunity for more of us to work together: recovery support services, treatment services, design and policy, perhaps even internationally, to better understand the relevant issues and to find solutions. Two heads are better than one, as they say. The main points I have been considering are:

• Outcome indicators that recognise the whole recovery journey • Outcome indicators and recovery systems that recognise and are not punitive towards

relapse • Indicators representing abstinence and non-abstinence based recovery and medication

assisted recovery. • Indicators that go beyond black and white ‘drinking / not drinking’, ‘using / not using’

including psycho-social-community measures. • Innovative ways of collecting data, including visual self-help tools

Some ideas from Vermont include:

• Medications to support recovery • Improvements in number and length of relapse, re-incarceration, housing, job, engagement

in recovery community


• Improved behaviour, sociability, stories, societal participation, giving measures, family measures

• Outcomes along the recovery journey, including those that come after stopping using / drinking

• How do you measure, being comfortable in your own skin? • Long term outcomes, reduced health care costs, improved family functioning, improved

community cohesion, improved giving back – become a positive force in the community. • Long term outcomes go beyond not causing harm to the community towards being a

positive force and unit to build up the communities in which people live: healthy relationships, giving back, starting new healthy cycles within families.

Advocacy and unity of the recovery movement Advocacy and unity of the recovery movement Advocacy and unity of the recovery movement Advocacy and unity of the recovery movement Everywhere I visited during the fellowship, people talked about the need to ‘mobilise’ the recovery community, to empower it to represent issues concerning people with current or past problems with drugs / alcohol, to challenge stigma and to inspire people to consider recovery. In these discussions, the topic of conversation often led to the organisation FAVOR (Faces and Voices of Recovery). Faces & Voices of Recovery is dedicated to organizing and mobilizing the over 20 million Americans in recovery from addiction to alcohol and other drugs, our families, friends and allies into recovery community organizations and networks, to promote the right and resources to recover through advocacy, education and demonstrating the power and proof of long-term recovery. Faces & Voices of Recovery was founded in 2001 at a Summit in St. Paul, Minnesota. In the 1990s, advocates and their national allies met to strategize on ways to reach out to the medical, public health, criminal justice and other communities about the possibilities of recovery from addiction to alcohol and other drugs, forming The Alliance Project. The project and its supporters found inspiration and support in the writings of historian William White and in the airing of a ground-breaking television series on addiction produced by Bill Moyers. The Alliance Project began planning for a national gathering; among their key tasks was the commissioning of the first national survey of the recovery community, The Face of Recovery. The St. Paul Summit was the culmination of from more than two years of work to provide focus for a growing advocacy force among individuals in long-term recovery from addiction, their families, friends and allies. The St. Paul Summit had three goals: 1) To celebrate and honour recovery in all its diversity 2) To foster advocacy skills in the tradition of American advocacy movements 3) To produce principles, language, strategy and leadership to carry the movement forward In discussions with FAVOR members, board members and representatives, Chris Wilkins from The Loyola Recovery Foundation, Carol McDaid (also co-founder of The McShin Foundation), Walter Ginter from the MARS project, New York and William L. White (eminent researcher) and as a result of visiting various projects through the USA, I witnessed the effects of the organisation:

• Training – people were empowered and speaking with a common language when they told me their recovery story

• Raising awareness – the spread of high-profile recovery walks throughout the States • The ‘recovery philosophy’ conversation, embracing different pathways to recovery • A unifying vision for the recovery movement and a means by which this can be

communicated • Resources for peer recovery support services, sharing best practice


• Networking – joining groups together from different parts of the country • Celebrating recovery – awards, recognition dinners • A diverse board and regional representatives

As the recovery movement in the UK is mobilised, the need for a unifying vision, a common language, shared resources and celebration would be excellent ways in which to ensure the movement is connected and therefore, better able to effect change for the benefit of individuals and communities. In her role as a lobbyist, advocate and FAVOR board member, Carol had lots of advice about how to develop Recovery Cymru. I was pleased to find that much of her advice was already at the core of what we do but she helped me to express it in words and plan for the future in a way I hadn’t yet started thinking about. We talked at great length about the wider recovery movement developing in the UK and the role Recovery Cymru might be able to play. For her, as a long standing member of FAVOR, the following points are very important:

• There’s no wrong door to recovery, every door should be open • Make the movement (and therefore recovery) attractive, fun • Create a big tent and grow numbers • Have a broad definition of the recovery community: people in recovery, family, friends,

professional allies • “Nothing about us without us”, people need to be involved • Organised recovery advocates, including training and support • Principles before personalities, the movement is more important that personal histories,

biases, problems • Earned media and human interest stories, the power of a story told well • Civil engagement is a responsibility of recovery • Actions speak louder than words, be visible and be proud

Recovery Cymru prides itself on embracing all paths to recovery & personalised definitions of recovery. We embrace people on all stages of their recovery journey and firmly believe that a dynamic and inclusive recovery community, with integrity, will empower people to find their path to recovery and support others to do the same. We have a diverse range of people with abstinence based, medication assisted and 12-step recovery within RC, as well as those who are new on their recovery journey and are ‘finding their path’. Here’s a link to our website with more information on our beliefs about recovery www.recoverycymru.org.uk/about. Having said that, we recognise that our approach will not be ‘right’ for everyone and are proud to be part of a wider recovery community growing in Wales. As Chris Wilkins, put so nicely, there is room – and need - for all of us! “Embrace your diversity and find ways recovery communities can connect on topics that can further the mission and focus of the wider recovery community – stigma, awareness raising, policy, recovery focused treatment etc. Celebrate what works for you, don’t feel pressured to change yourself or conform to the political or social landscape. However, be aware of what the people in the community want, developments there are in philosophy and experience and react to that.” Medication assisted recoveryMedication assisted recoveryMedication assisted recoveryMedication assisted recovery As I briefly touched upon above as I described my time with MARS in New York City, “One of the most complex, conflict-ridden, and stigma-laden topics of discussion within recovery circles and the larger culture is that of medication-assisted recovery.” Lisa Mojer-Torres (2007).


It became increasingly apparent during my fellowship that the US recovery movement is evolving. what was once heavily 12-step, abstinence-based, is now growing to embrace other methods and philosophies, recognising that there are growing numbers of recovering people who ‘got there’ by a different route. In the UK, there have been growing tensions with suspicions being raised that ‘the recovery movement wants to do away with harm reduction and ostracise people on methadone’. This is not true! As with any growing movement, there will be differences of opinion and debates to be thrashed out. However, communication is key! Many of the misconceptions, rumours and ‘heated debates’ have been sparked by a lack of clarity and communication – from people on all sides of the argument. I am pleased to say that Welsh and UK-wide networks are forming that aim to ‘keep the conversation going’. My aim is that we will find a unifying vision for the recovery movement, embracing diversity and making real and positive change to the treatment system for the benefit of the individuals who use that system. Lisa, an eminent medication-assisted recovery advocate in the USA, goes on to say, “Inclusiveness is one of the distinctive core values of the new recovery advocacy movement. That value is predicated on the belief that there are multiple pathways and styles of long-term recovery and that the shared elements of those pathways and styles are more important than what distinguishes them.”


Fellowship legacyFellowship legacyFellowship legacyFellowship legacy Drawing on and reflecting upon my fellowship experiences is an on-going process. I feel I am continuing to process, interpret and formulate new ideas as Recovery Cymru grows and as our work expands. Below is a summary of the story since I returned. The aims of Recovery Cymru have been tangibly described as:

1. To support the development of a dynamic and diverse grass roots, self-help recovery support community in South Wales

2. To advocate, advise and campaign on wider recovery issues, including a) the development of Recovery Oriented Systems of Care in Wales and b) raising awareness of recovery to challenge stigma, discrimination and prejudice

We have signed a two-year lease on premises in Cardiff, made possible by a local authority grant. We have one year left of a two-year funding grant from the Welsh Government, which will result in a research project being conducted on recovery Cymru. We are developing Recovery Cymru in the Vale of Glamorgan which is an exciting prospect and requires us to think creatively to adapt our model for the rural demographics of the area. Again, ‘the power of the people’ has driven this development as we have some members and volunteers who live in the Vale of Glamorgan and are keen to be involved in starting new groups and activities. Recovery Cymru has partnered with Newlink Wales to develop an ‘Embracing Recovery’ training programme for people delivering substance misuse (and related) services. We piloted the first sessions in March, receiving positive feedback and are currently refining the course for future participants. We will be delivering a training session to prison staff in April. I sit on the new Welsh Government ‘Advisory Panel on Substance Misuse’ recovery sub-group which has been formed to define and develop the recovery agenda in Wales. We are launching a new ‘Social Enterprise’ called ‘Recovery Gifts’ which has evolved out of our craft group. We will be producing quality handmade products for sale, giving members and volunteers opportunities for work experience and volunteering, as well as developing employment opportunities. More information can be found at www.recoverygifts.com I will shortly be speaking at the National Drugs Conference on ‘harm reduction and recovery’. This is a good opportunity to increase the dialogue between the growing recovery movement and those who may have concerns about how recovery embraces differing philosophical leanings and models. I am looking forward to having the opportunity to dispel some of the myths I have anecdotally heard have been murmuring around the UK and hope to find some core issues on which we can unite which best supports the good practice that has been developed, while offering the opportunity to jointly make improvements where there is need.

Recovery Cymru was privileged to work alongside other organisations in Cardiff (including The Living Room which was developed by Wynford Ellis Owen, a fellow Winston Churchill Fellow!), to organise the First Welsh Recovery Walk in September 2011. It was a huge success, energising people to ‘Put a Face and a Voice to Recovery’ and attracting media coverage. We are planning a second walk for 2012.


Having a laugh on recovery coach training

Building on some of the ideas I explored throughout my fellowship about Recovery Coaching, members and myself have started developing our recovery coaching programme. Excitingly, Recovery Cymru is also involved in the development of a Single Point of Engagement (called Umbrella) for all substance misuse treatment in Cardiff and the Vale of Glamorgan, in which we will be contributing the expertise of lived experience by situating Recovery Champions in the Umbrella team.

Most importantly, our membership and volunteers have continued to grow and flourish. The atmosphere in the centre is great and our activities are growing as more and more people are encouraged and supported to combine their passion and ideas. Here is some of the feedback we have received: “Recovery Cymru members by their example, prove that recovery is possible and by that process enhance people’s self-esteem, enabling them to overcome pre-conceived prejudices and improve the quality of not only their life, but also the lives of those dear to them.” Paul, RC member “Recovery Cymru provided a safe and secure environment in which to give and receive support without being judged. This has enabled me to be totally honest about the triumphs and struggles I have undergone over the past 9 months since I stopped drinking. Thank you RC.” Susie, RC member "RC has been key to helping me maintain positive changes to my life by providing me with a sense of both purpose and belonging.” Gareth joseph, RC member and recovery coach “RC: bridging the gap between alcohol and prescribed medication dependence, treatment and a return to the real world.” NH, RC member, former Cardiff rugby first team player and police officer “Ever heard the saying ‘saved me from a fate worse than death’? Well that is what RC did for me, obviously not without support from other agencies. I had attended Newlands Drug and Alcohol centre, where I had been administered ‘Antebuse’. This may work for some people but unfortunately not for me. My problem with alcohol was because of boredom/loneliness, I was ok in the day but found the evenings especially difficult. I was given a leaflet with RC details on it and decided to give them a call. RC is a self-help group, so there is no judgement or assumptions, the people who run it and those who attend do so because they have all been affected by either drugs/alcohol so they know where you’re coming from. I attended an evening cookery group where people met up and all pulled together to cook and prepare a meal. The atmosphere was friendly and open. The group sat down and ate together which was really great. I know that RC are interested in starting a group in the ‘Vale of Glamorgan’, this would be an excellent idea as there is nothing in the Vale that meets this demand. I have thoroughly enjoyed attending these evenings and it has given me a lifeline back into a social atmosphere. So, many thanks to my friends at RC, I hope we can go from strength to strength and support anybody who wants to come along. I for one would recommend it.” Elaine, RC member "Being part of RC has truly been a positive experience for me in my Recovery journey. RC provides a warm, friendly, supportive environment, in which people can share their experiences and feel at


ease with people who understand. They can also make new friends with people going forward in their own lives & recovery journeys. There is a wide range of activities and social groups: there’ something for everyone, for people from all walks of life with alcohol and drug problems and other issues.” Stuart, RC member and recovery coach “RC holds the key to freedom from addiction if you want it. It values everyone’s opinion and encourages expression of those opinions. By respecting and listening to my belief that responsible behaviour is a choice and addictive behaviour an irresponsible choice, I have been able to break my alcohol addiction cycle and get busy living.” Sean, RC member “The work of RC is so important! They have an amazing way of responding to the real needs of people in recovery and the result is inspiring. We have seen real change in the people who engage, you can see them growing. It's been a pleasure working with RC; they are one of our most valued partners.” Lindsay Bruce, Newlink Wales “Having had the opportunity to work with RC since its inception I have seen how the charity has grown over the past year-and what a growth that has been! RC members have identified and created a variety of groups to meet the needs of those in recovery, from recovery support groups, women’s groups to cooking social evenings! The laid back and inclusive atmosphere at RC encourages members to give and receive support, no matter what stage they are in their recoveries or what their personal journey looks like. Everyone helps to make people to feel welcome and supported and learn new skills. Having spoken to a number of the RC members I have been overwhelmed by the sense of community and belonging that they experience and how this helps to boost their self-esteem and pursue other avenues in life away from the culture of substance misuse.” Lucie James, Chair of trustees


Conclusions Conclusions Conclusions Conclusions Recovery oriented treatment systems – changing the system The development of Recovery Oriented Integrated Systems will allow services to provide a genuine pathway of options, choices and services for people seeking professional help. Workforce development Training for front line staff, managers, commissioners and policy makers is critical in establishing the recovery model and in increasing awareness and dialogue between providers and the people who use services. Bridging the divide between treatment and the community Dialogue between the grass roots recovery movement and the treatment system is essential in effecting change and creating a positive culture in which recovery can thrive Developing the recovery movement in the UK The recovery movement must seek to create ‘a big tent’ in which all methods, philosophies and lived experience of recovery can thrive. Joining on unifying issues such as raising awareness of recovery will be an important way to ensure wider unity between different peer-led recovery groups. The growing connections and networks of recovery groups, both in Wales and the wider UK will be critical in this. Recovery support in the community Grass roots recovery networks are growing! This is hugely exciting. I think there needs to be some thought and discussion around how recovery groups are supported and accepted by the substance misuse treatment sector, whilst also remaining independent, genuinely community-led and community-based. Putting a face and a voice on recovery Challenging stigma, discrimination and prejudice is vital. The recovery movement has an opportunity to engage the wider public to raise awareness of both the problems people face and the positive message of recovery. Employment, bring it out of the shadows, encourage people to seek help when they need it, increase awareness in families. Communication is key Between all stakeholders to reduce misinformation, polarisation and myth. Choice There are many paths to recovery. This knowledge should drive the movement and system redesign.


Photo diary Photo diary Photo diary Photo diary The fellowship was a trip of many firsts for me. I’ll be forever grateful for all the professional and personal experiences I had!

First time in a helicopter! First time at a baseball game! With Bethan

Bartholomew.

Cycling the Golden Gate bridge A visit from my then-fiancé Henry

A long-held dream fulfilled, visiting the Grand Canyon A big smile upon being released from Alcatraz!

addiction recovery, community & self help: grassroots ... · my fellowship was entitled:...

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