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Positive Social Networks&
Recovering from Addiction
Mark Gilman, Strategic Recovery Lead, Public Health England
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5th Wave Public HealthAsset Based
Community DevelopmentABCD
Mutual Aid(AA, SMART)
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Positive Social Network
Mutual Aid (MA)
MA Brand X
MA Brand Y
MA Brand Z
PHE Endorses
BUTPHE does not endorse any
MA ‘Brand’
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6
What & Who are we talking about?
Abstainers
Binge Drinkers
SOCIAL (“successful”) Drinkers and Users
Heavy Users
“Addicts” & “Alcoholics”
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Drug dependency, “addiction” & “addicts”Alcohol dependency, “alcoholism” & “alcoholics”
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Health Warnings & Clarifications
• “Addiction” & “Alcoholism”• Not technically Twelve Step Facilitation as per
manuals• Not just about 12 step fellowships• It is equally about SMART Recovery Mutual Aid• It is about getting people into a support network• Social relationships are a matter of life and death• Asset Based Community Development (ABCD)
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Behaviours in Public Health Context
• Smoking tobacco - COPD (e.g. Emphysema)• Eating too much bad stuff (sugar addiction?) – “Diabesity” obesity &
type 2 diabetes• Not taking exercise• Drinking too much alcohol (how much is ‘too much’? UK, USA, Europe?• Smoking “skunk” type high potency cannabis• NPS (New Psychoactive Substances, ‘legal highs’) • Sniffing Cocaine and taking Ecstasy (UK ‘recreational’ drug use?)• “Addiction” to alcohol, benzodiazepines, opioids (heroin) and crack
cocaine• Socially Isolating • Committing acquisitive crimes to raise funds to buy drugs• Contracting and transmitting BBVs
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“The Perfect Storm of Addiction”&
Inter Generational Transmission
Genetic Predispositio
n
Childhood ‘Trauma’
Early Access to drink and
drugs
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Continuum of involvement with substances
Occasional Use
• e.g. Drink Driving
Harmful Use
• Physical Dependency
Overwhelming involvement
• “Addiction”
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What kind of substance problem?
Binge Drinker/User?
Heavy drinker/User?
“Alcoholic”? Alcohol “Addict”?
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What do different types need to do?
Bingers Get a different hobby
Heavy Users Control your drinkingKeep a drink diary
“Alcoholics”“Addicts”
Stop & Stay Stopped
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Why choose Abstinence as a basis for Recovery…?
“…because you have to turn the water off to mend the plumbing”
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“Alcoholics” and Controlled Drinking
“…down to one beer a day now!”
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“Alcoholics” alone & thinking:“I’ll just drink at the
weekend!”“I will only drink good red wine!”
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Positive Social Networks• PHE supports the evidence for the powerful benefits of positive social
networks in sustained recovery from addiction. • Different kinds of groups and approaches work for different people, as
acknowledged in recent NICE guidance. • PHE does not recommend 12-step mutual aid above other evidence-based
alternatives. • PHE is committed to promoting improved access to mutual aid for
everyone who can benefit from it and we are in the process of developing a work stream to deliver this ambition.
• There is no single route to recovery: the availability of a choice of options in recovery support, as in treatment, is fundamental to our vision.
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“I’d rather have a bottle in front of me than a frontal lobotomy!”
Recovery History – the role of AA
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Gold Injections, Aversion Therapy, Eating lemons… and much worse in Nazi Germany
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“The icy intellectual mountain in whose shadow I had lived and shivered many years…”
“I stood in the sunlight at last”
Spiritual awakening
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• Positive Social Network
• Recovery Community
Treatment
Bio-Medical and Psychological Treatments
+ Positive Social Networks
BIO PSYCHO SOCIAL
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Social relationships: Overall findings from this meta-analysis
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
Social relationships have big impact: comparative odds of decreased mortality
Social relationships: High vs. low social support contrasted
Social relationships: Complex measures of social integration
Smoking <15 cigarettes daily
Smoking cessation: Cease vs. continue in patients with CHD
Alcohol consumption: Abstinence vs. excessive drinking
Flu vaccine: Pneumococcal vaccination in adults
Cardiac rehabilitation (exercise) for patients with CHD
Physical activity (controlling for adiposty)
BMI: Lean vs. obese
Drug treatment for hypertension in populations > 59 years
Air pollution: low vs. high
Holt-Lunstad J et al. PLoS Med. 2010;7:e1000316
Social relationships have as great an impact on health outcomes as smoking
cessation, and more than physical activity and issues to address obesity
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Who Recovers?
1. Everyone CAN recover2. Not everyone WILL recover3. We don’t know WHO will recover4. So, give everyone EVERY CHANCE
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What does “Every Chance” look like?
Psychotherapeutic
Social NetworksSocial
Relationships
Bio Medical
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I’m In Treatment but Socially Isolated?
• But, I’m alone…
• I’m alive
• I’m not in prison
• I’m HIV free
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Welcome to Recovery:a positive social network
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Recovery does slowly what drink, drugs & medications do fast...
...changes perception of reality.
Learning how to fit in
To live life on life’s terms
Free from addiction
“Community as method”
Recovery community a place where you learn how to live
right, with other people...
Free from fear…
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CONNECT?Groups?
Mutual Aid?Nah! I can do it on my own!
“I'm not getting in that lifeboat me!”
“Keep rowing people!”
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• Self Management
• Self Care
• Recovery Community
Treatment
From Bio-Medical Treatment and Psychological Support to Self Management
and Self Care
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CONNECT(Five ways to wellbeing)
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Getting Started? A Map…TOPIC ACTION SCORE 5=High 1=Low
5 4 3 2 1
Connect •SMART RECOVERY•AA, NA, CA, OA...•Weight Watchers•Stop Smoking Groups•Peer Led Groups
Be Active •Exercise
Give •Volunteering•Community Involvement
Keep Learning •Further Education•Hobbies
Take Notice •Mindfulness•Spiritual ActivityPresentation title - edit in Header and Footer
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“Co-Production” of Recovery
R ECOVERY
COMMUNITY
TREATMENT
5 ways to well being
“You alone can do it but you can’t do it alone”
TreatmentPlan
Recovery Plan
Long term, in treatment population
Co-Dependency?
“You can check-out any time you like,But you can never leave! "
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Identifying and changing social networksQ. Who do you spend your time with in a typical week?
Positive Pro-Recovery
people IN
NegativeAnti-Recovery
people OUT
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“Crabs in a Barrel”
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“There is a Solution we know
How it Works”
“I can’t but WE can”
“You alone can do it but
you cannot do it alone”
REDISCOVERINGALCOHOLICS ANONYMOUS POSITIVESOCIALNETWORK
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Assertive Linkage to Mutual Aid
• SMART Recovery UK
• Twelve Step Facilitation UK
• “You alone can do it but you cannot do it alone
• “I cant but WE can”
• "The therapeutic value of one “addict” helping another”
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Social CapitalRobert D. Putnam (‘Bowling Alone’ and ‘Better Together’)
“The sense of mutuality that we feel for one another that expresses itself in trust and care…Your good being bound together with my good.”
• Bonded Social Capital • (within)
• Bridging Social Capital • (between)
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Bridging Social Capital (between)“We are people who normally would not mix” AA Big Book
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Recovery as social justice?
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“I’d rather have a bottle in front of me than a frontal lobotomy!”
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HUMBLE DOCTORS: “I CANT HELP YOU ROWLAND”,
“SPIRITUS CONTRA SPIRITUM”
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HUMBLE DOCTORS:
“KEEP DOING WHAT YOURE DOING BILL!”
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"The therapeutic value of one addict helping another”
An Asset with
“more than 2 million
members” Wikipedia
Public Health and Mutual AidAlcoholics Anonymous (AA) Recovery since 1935
“I cant but WE can”
“You alone can do it but you cannot do it
alone”
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Bruce Alexander: The Globalisation of Addiction –
A Study in “Poverty of the Spirit”