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

2. 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”

3. Asset Based Community Development
Big Ideas
SANITATION
Asset Based Community Development

4. Why remodel the systems?

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

6. “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”

7. 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

8. bridging the gap…
Recovery Community
Treatment Community

9. bridging the gap…prison to recovery
Recovery Community
HMP Treatment
Recovery Wing

10. 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

11. 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

12. 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?

13. 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’.

14. 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

15. Treatment Plan Review

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

17. 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

18. 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)

19. 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.

20. “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

21. 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”)

22. 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

23. 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 %
Litt et al – “Changing network support for drinking” (2009, (p230))

24. 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

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

26. 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

27. 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

28. Recovery Pioneers & Champions

29. RECOVERY CHAMPIONS
&
QUALITY CONTROL

30. “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

31. The Lifestyle of Active Addiction

32. The Lifestyle of Recovery

33. 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)

34. 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...

35. 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

36. 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

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

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

39. “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

40. 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

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