Mutual aid and its facilitation Steve Taylor, Alcohol & Drugs, PHE 10 April 2013

Why social networks matter Meta analysis: comparative odds of decreased mortality Social relationships have as great an impact as smoking cessation, and more than physical activity and issues to address obesity Source: Holt-Lundstad et al 2010 Mutual aid April 2013

Five ways to wellbeing 5 ways to well-being important to all. May be especially lacking in drug users and needing attention during recovery, to support recovery. Mutual aid can contribute to most of the 5 ways – even ‘be active’ if people walk or cycle to meetings! Mutual aid April 2013

NICE “routinely provide people who misuse drugs with information about self-help groups.” “consider facilitating the person’s initial contact with the group, for example by making the appointment, arranging transport, accompanying him or her to the first session and dealing with any concerns.” NICE CG51, 2007 Echoed in quality standard (QS23, 2012) And similar for alcohol (CG115, 2011) Mutual aid April 2013

Recovery Orientated Drug Treatment What? “Strengthen or develop patients’ social networks, involving families where appropriate and facilitating access to mutual aid by, for example, providing information, transport, or premises for meetings, and by bringing local recovery champions into the service to meet patients.” When? In every phase of treatment and beyond Mutual aid April 2013

NTA/PHE recovery resource Helping clients to access and engage with mutual aid “Treatment providers and keyworkers who actively help service users to access and engage with mutual aid are likely to see better outcomes. But it means doing more than simply providing information or hosting meetings…” This resource – one in a series supporting practical implementation of the Strang report – forms the basis for much of what follows. Mutual aid April 2013

Who recovers? Everyone CAN recover Not everyone WILL recover We don’t know WHO will recover So, give everyone EVERY a chance We also don’t know HOW people will recover so try to engage everyone with mutual aid Mutual aid April 2013

Is it effective? Effectiveness Improves substance misuse outcomes (NICE, 2007, 2011, 2012) Extra effect when combined with structured treatment (Fiorentine & Hillhouse, 2000) The addition of just one abstinent person to a drinker’s social network increased the probability of abstinence in the next year by 27% (Litt et al., 2009). Cost-effectiveness Over 3 years per-person treatment costs for AA group: 45% lower than ‘professional’ treated groups with similar outcomes Mutual aid (AA) reduces on-going treatment costs (Humphreys, 2004) Mutual aid April 2013

Mediators of effectiveness How specific are the mediators of AA's effectiveness? "Changes in active coping behaviours, cognitive appraisal of the advantages and disadvantages of drinking, and self-efficacy may seem more the stuff of cognitive-behavioral psychotherapy than of a 12-step self-help organization. But even the most spiritually minded AA meetings and texts offer extensive practical advice, which any cognitive-behavioral theorist would endorse even though the jargon would be unfamiliar” Circles of Recovery, Keith Humphreys Mutual aid April 2013

Mediators of effectiveness How specific are the mediators of AA's effectiveness? Circles of Recovery, Keith Humphreys CBT 12-step monitor for relapse-promoting cognitive distortions no stinking thinking adopt behavioural changes that are congruent with more positive mood fake it until you make it use stimulus-control methods to eliminate alcohol consumption avoid slippery people, places, and things Mutual aid April 2013

What can you do? Learn about it “There is a principle which is a bar against all information, which is proof against all arguments, and which cannot fail to keep a man in everlasting ignorance - that principle is contempt prior to investigation.” Attributed to Herbert Spencer (in Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism), after William Paley 1794 Read Watch Learn GO! Mutual aid April 2013

What can you do? Host/promote/support meetings Provide space Provide literature Bring in speakers Use peer mentors and recovery champions Remind people about their meetings Escort them Mutual aid April 2013

What can you do? Synergise attendance Include in care planning Reflect in keywork Journal Maps ‘3-Step Referral Method’: Handouts, worksheets, research and guides available from www.mentalhealth.va.gov/providers/sud/selfhelp Mutual aid April 2013

Recovery Resources http://www.nta.nhs.uk/recovery-resources.aspx Helping clients to access and engage with mutual aid: www.nta.nhs.uk/uploads/rr_facilitatingmutualaid _jan2013[0].pdf Mutual aid April 2013