Treatment & RecoveryIntegrating Professional & Recovery-Orientated Principles

Mark Gilman

Strategic Recovery Lead

National Treatment Agency

1. Make Contact

2. Maintain Contact

3. Make Positive Lifestyle Changes

Whole family and community based solutions:

“I can’t but WE can”

The New Public Health 1987

Public Health & Asset Based Recovery 2011

Big Ideas

SANITATION Asset Based Community Development

Why remodel the systems?

Me, Myself and I – in treatment and alone

Social Isolation

ME

MYSELF

I

"The therapeutic value of one addict helping

another”

75 years on:“more than 2

million members” Wikipedia

Rediscovering AA: Recovery 1935; “The Enlightenment”

(See Griffith Edwards

On Lifeline’s FEAD)

“I cant but WE can”

“I cant but WE can”Recovery Champions and Community as Method, (ref: George De Leon)

Active addiction is about ME, ME, ME - “Self will run riot”

A dark and lonely place; “poor me, poor me, pour me a drink”

Recovery is about a group, a community, of people coming together to find a common solution – sharing our “experience, strength and hope”

“We can do things together, we cannot do alone”

“Your recovery is my recovery”

Coming together to change lifestyles and identities

Treatment is an episode in the recovery process

If recovery was a journey from Manchester to London treatment is taxi to station

Recovery Community

Treatment Community

bridging the gap…

Recovery Community

bridging the gap…prison to recovery

HMP TreatmentRecovery

Wing

A Therapeutic Community Perspective (George De Leon cont’d)

“RIGHT LIVING”

Recovery beliefs and values for social learning, personal growth and healthy living include:

• Truth and Honesty

• Here and Now – “The Power of Now” (its all we’ll ever have)

• Personal Responsibility for Destiny (be the revolution you want to see)

• Social Responsibility ("Brother's/Sister's Keeper")

• Moral Code Concerning Right and Wrong Behavior

• Work ethic – “The Fairy Jobmother” - Recovery Guru?

• Inner Person is "Good", but Behavior Can be "Bad"

• Community as method teaches individuals to use the community to change

themselves

Vertical and Horizontal Co-Production of Recovery New Presentations (including “recyclers”) - Down and Across

Increase Successful Completions

“Those who successfully

complete don't hang

around”

R ECOVERY

COMMUNITY

R ECOVERY

COMMUNITY

TREATMENTTREATMENT

5 ways to well being

“You alone can do it but you can’t do it alone”

TreatmentPlanTreatmentPlan

Recovery PlanRecovery Plan

DOWN

ACROSS

Tuesday 18 April 2023

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StartStart

Long term, in treatment populationLong term, in treatment population

Me, Myself and I – in treatment and aloneAlive and out of prison

But:- Health Apathy

- Marmot, Health Inequalities gap? - Inter-Generational transmission?

ME

MYSELF

I

Long term, in treatment population - Social IsolationLong term, in treatment population - Social Isolation

5 ways to well being in Recovery

1. Connect… With people around you. Go to meetings (AA, NA, CA, SMART)

2. Be Active…do something, go for a walk, exercise, do anything.

3. Give… Do something for someone else. Volunteer.

4. Keep Learning… Try something new. Become a student of recovery?

5. Take Notice… Be curious. Be present. ‘The Power of Now’.

Vertical and Horizontal Co-Production of Recovery Long term, in treatment population – Up and Across

R ECOVERY

COMMUNITY

R ECOVERY

COMMUNITY

TREATMENTTREATMENT

Recovery PlanRecovery Plan

ACROSS

5 ways to well being

“You alone can do it but you can’t do it alone”

TreatmentPlan Review

TreatmentPlan Review

UP

Mark Gilman,Tuesday 18 April 2023

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Long term, in treatment population - Social IsolationLong term, in treatment population - Social Isolation

Treatment Plan Review

Recovery CommunitiesRisky and Ambitious?

“A life beyond your wildest dreams”

5 Ways to System TransformationTimetable

Tuesday 18 April 2023

1. Commissioners write to all providers to articulate recovery vision

2. Providers write to and train all staff in Recovery Oriented Drug Treatment (Professor John Strang report)

3. Providers implement Co-Production of Recovery model for all new and recycled patients/clients

4. CJS services focus on X number of DIP and Prison “frequent flyers”

5. Providers write to all long term patients to set up Treatment Plan Reviews

___________________?

___________________?

___________________?

___________________?

___________________?

The Management Challenge

•Employee satisfaction, patient experience, recovery outcomes.

•Organisational ethos and culture more important for recovery outcome than any patient/client characteristic.

•Organisational Readiness for Change (ORC): Staff must accept need for change and believe that the initiative will work.

•Assertive linkage to communities of recovery:

“The addition of just one abstinent person to a social network increased the probability of abstinence for the next year by 27%” (p230)

27% Litt et al – “Changing network support for drinking” (2009)

Framingham Heart Study, Christakis and Fowler Surround yourself with Recovery

A person’s odds of becoming obese increased by 57% if they had a friend who became obese, with a lower risk rate for friends of friends, lower again at three degrees of separation

Smoking cessation by a spouse decreased a person’s chances of smoking by 67%, while smoking cessation by a friend decreased the chances by 36%. The average risk of smoking at one degree of separation (i.e., smoking by a friend) was 61% higher, 29% higher at two degrees of separation and 11% higher at three degrees of separation.

Node = a person

Line = a relationship between two people

“embedded”: the degree to which a person is connected within a network

more embedded = central

less embedded = periphery

Terms• Contagion: what flows across ties (germs, money, violence, fashions, organs, happiness, obesity, etc.)• Connection:

who is connected to whom (ties to family, friends, co-workers, etc.)• Homophily:

the tendency to associate with people who resemble ourselves

(“love of being alike”)

The Obesity “Epidemic”• 66% of Americans are overweight or obese• From 1990 to 2000, the percentage of obese people in the USA increased from 21% to 33%

1975 1990

Green Node: nonobeseYellow Node= obese (size of circle is proportional to BMI)

DonutOr

Lettucefor

Lunch?

•Creating Recovery Communities

•Changing Social Networks

•Organising Recovery Communities

“The addition of just one abstinent person to a social network increased the

probability of abstinence for the next year by 27% Litt et al – “Changing network support for drinking” (2009, (p230))

Rosenquist, Murabito, Fowler and Christakis (2010) – from the Framingham Heart Study

12,067people with data collected every 2-4 years

Principals are 50% more likely to drink heavily if a person they are directly connected to drinks heavily; 36% more likely at two degrees of separation; 15% at three degrees of separation.

People are 29% more likely to abstain if someone they are directly connected to abstains. This effect is 21% at 2 degrees of separation; 5% at three degrees of separation

“We are family!” Hard Wired to Attachment

“We may not need everybody but all of us need somebody”

Is Recovery a process of Emigration & Immigration?

RECOVERY LANDRECOVERY LAND

RECOVERY COMMUNITYRECOVERY

COMMUNITY

“We’d like to thank community treatment for keeping us alive and out

of prison”

Treatment and Recovery: Content, Themes & Characteristics

Treatment:Acute Short Term interventions

“I” for Individual, Individualism

Medical & Clinical

Risk Averse

Apathetic

Talking therapies

•Aftercare•Day Programmes (CBT)

Residential Treatment

Professionals as Experts

Recovery:Long term process

“We” as in Community, Mutualism

Social & Communal

Embraces Risk

Ambitious

Activities “Doing stuff” (walking, sport)

•12 Step Mutual Aid (NA, CA, AA)•SMART Recovery (CBT)

Recovery Housing & Employment

“Recoverees” as Experts

Recovery Pioneers & Champions

TREATMENT

RECOVERY CHAMPIONS

&

QUALITY CONTROL

Recovery Communities

Community Treatment

Is community treatment part of the world of: Active Addiction or Recovery Community?

“Where do I find this recovery

stuff?”

The Lifestyle of Active Addiction

The Lifestyle of Recovery

Recovery; Titanic and cost of a Big Book

Were first-class passengers on the titanic twice as likely to survive (“Recover?”) as the average passenger?

Price of Big Book = £17,200?

Price of Big Book = £1.72? (+p&p)

Recovery does slowly what drink and drugs do fast...

...changes perception of reality.

Learning how to fit in

To live life on life’s terms

Free from fear

Free from addiction

“Community as method”

Recovery community a place where you

learn how to live right, with other people...

PHP 5 year Treatment and Recovery ProgramSkipper and Dupont (2010)

Find a motivation fulcrum (a good reason to change)

Provide comprehensive initial assessment and extended treatment

Provide care management for many years

Have a high expectation for abstinence-based recovery

Assertive links to recovery support groups (NA, AA, CA, SMART)

Sustain motivation and support and where necessary, re-intervene

Reintervene at a higher level of intensity at any sign of relapse

Integrate these elements where possible within a comprehensive programme

PHP outcomes

64% completed the 5-year programme

72% of participants were working in their chosen profession at the follow-up point

79% of participants had no positive tests during follow-up

PHP 5 year Treatment and Recovery Program

Total Participants 900

Number on Opioids 300

Number injecting Opioids 150

Number placed on methadone 1

Q. Who’s on this PHP?

A. Addicted Doctors

PhysicianHealth Programme

“The Power of Recovery”(Personal communication with Phillip Valentine, Executive Director, CCAR, Connecticut Community for Addiction Recovery)

Time

Pot

enti

al

“Normal People”

“Recovering People”

“Long Term Recovery”

“Better than well”

“A grateful addict/alcoholic”

“Model citizens”“Early Recovery”

“5 years+

In recovery”

Deficit Based Approach Asset Based Approach

Weaknesses Strengths

Outside In Inside Out

Dependence on outside Professionals Dependence on each other

Consumers of services Partners in provision of services

Professionals non-judgemental training makes challenge difficult

Challenge each other to “do the right thing”

Disabilities Abilities, capacities, Assets

Client Citizen

Passive victim of problems Active participant in solutions

Treatment - Recovery - ABCD

Commissioned

Treatment

RecoveryIncludes AA, NA, CA

SMART

ABCD

Asset Based Community Development