POLICY RECOVERY Voluntary self control over substance use plus health and wellbeing plus re- integration Push for abstinence – planned discharges substance free Training & employment Housing Friends/relationships PUBLIC HEALTH Reduce Blood borne viruses Reduce drug and alcohol related deaths Reduce health inequalities Increase life expectancy Increase health & wellbeing Smoking cessation Prevention
Evidence WHAT RECOVERY OUTCOMES White( 2012) 407 studies: around 50% with substance dependency achieve remission: 20% do so through abstinence. Cannot tell until someone is in stable remission until after 5 years Different people have different recovery capital/ potential Some substances are more difficult to achieve remission from
Evidence RECOVERY OUTCOMES Heroin is sticky First 6 mths to a yr in treatment – most potential for change (NTA) Drug outcomes improving in England since mid 1990’s 75-65% heroin users stopped using 3-5 yrs (NTORS etc). 30 yr follow-up study: Grella and Lovinger (2011) Of survivers 40% in stable remission but normally after 5-8yrs in opioid substitution, 25% did not reduce use at all.
Evidence HEALTH OUTCOMES Substance dependence causes significant collateral health damage, directly or through associated lifestyle – smoking, diet, hygiene etc 33 yr follow-up study: 50% heroin users dead (Hser 2007) Alcohol - mental health, cognitive damage, liver disease & and `system damage’ – cancers Injecting drugs – infections, vein damage & DVT, heroin overdose risk & death Smoking tobacco, cannabis, crack lung & heart disease Teeth !!!
Evidence EMPLOYMENT OUTCOMES International evidence suggests this is the most difficult to achieve Those employed on starting treatment likely be employed at follow -up and visa versa UK worst rate of unemployment in drug users compared to EU & USA BUT Education, training & voluntary work helps recovery & happiness CRIME OUTCOMES Substance - driven crime outcomes good if people achieve remission
Evidence SOCIAL OUTCOMES Having supportive friendship/family networks is paramount NICE: Mutual Aid, Family Therapy and Behaviour Couples Therapy Wellbeing research: friendship group of more than 3 = happiness
Some great guidance and tools Drug Matrix: Evidence for effective treatment: FINDINGS....
Overcoming dependence takes time Manager competence clear pathways - staff and service users know Track progress of clients particularly heroin users eg using `MAR’ data Review clients every 3 months If treatment not working – optimise Data/reviews to track clients progress and key workers caseload & complexity
Workforce competency improvements Health screening, assessment, treatment better harm reduction & health treatment when using better treatment for health issues when in treatment Evidence-based behaviour change interventions Empowering service users rebuild lives Helping (re) establish constructive relationships Education, training and meaningful activities Longer term health & wellbeing strategies
Reality check EXTENSIVE APPROACH needed ie longer term support but can we afford to do this PbR EXPECTATIONS................failing More health improvement & treatment More competence in behaviour change techniques –with fidelity & supervision Re-commissioning risks: TUPE, Disruption Smaller financial envelop risks of `Dumbing down’ loss of `expensive workers’
EG Well-being amongst staff and clients `Five Ways to Wellbeing’ framework. Staff & service users have 5 ways plans Teams have 5 ways activities & funding