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

3. Make Positive Lifestyle Changes “I can’t but WE can” The New Public Health 1987 Public Health & Asset Based Recovery 2011 1. Make Contact 2. Maintain Contact 3. Make Positive Lifestyle Changes Whole family and community based solutions: “I can’t but WE can”

Asset Based Community Development Big Ideas SANITATION Asset Based Community Development

Why remodel the systems?

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

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

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

bridging the gap… Recovery Community Treatment Community

bridging the gap…prison to recovery Recovery Community HMP Treatment Recovery 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 Start TREATMENT R E C O V Y M U N I T Increase Successful Completions “Those who successfully complete don't hang around” T I M E Treatment Plan D O W N Recovery Plan ACROSS 5 ways to well being “You alone can do it but you can’t do it alone” Sunday, 16 April 2017 Long term, in treatment population

Long term, in treatment population - Social Isolation MYSELF I Me, Myself and I – in treatment and alone Alive and out of prison But: - Health Apathy - Marmot, Health Inequalities gap? - Inter-Generational transmission?

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

Vertical and Horizontal Co-Production of Recovery Long term, in treatment population – Up and Across TREATMENT 5 ways to well being “You alone can do it but you can’t do it alone” R E C O V Y M U N I T T I M E ACROSS Recovery Plan U P Treatment Plan Review Long term, in treatment population - Social Isolation Mark Gilman,Sunday, 16 April 2017Sunday, 16 April 2017

Treatment Plan Review

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

5 Ways to System Transformation Timetable Commissioners write to all providers to articulate recovery vision Providers write to and train all staff in Recovery Oriented Drug Treatment (Professor John Strang report) Providers implement Co-Production of Recovery model for all new and recycled patients/clients CJS services focus on X number of DIP and Prison “frequent flyers” Providers write to all long term patients to set up Treatment Plan Reviews ___________________? Sunday, 16 April 2017Sunday, 16 April 2017

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.

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

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

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

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

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

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

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

Treatment and Recovery: Content, Themes & Characteristics Acute Short Term interventions “I” for Individual, Individualism Medical & Clinical Risk Averse Apathetic Talking therapies Aftercare Day Programmes (CBT) Residential Treatment Professionals as Experts 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

RECOVERY CHAMPIONS & QUALITY CONTROL

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

The Lifestyle of Active Addiction

The Lifestyle of Recovery

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

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

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

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

PHP 5 year Treatment and Recovery Program Total Participants 900 Number on Opioids 300 Number injecting Opioids 150 Number placed on methadone 1

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

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

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