1. Slide 1 WHAT'S THE POINT OF TREATMENT? Mark Gilman Strategic Recovery Lead

2. WHAT'S THE POINT OF TREATMENT? Reduce CrimeReduce BBV Transmission Initiate Long Term Recovery

3. Big Ideas SANITATION Asset Based Community Development ABCDABCD

4. 1. Make Contact - ACCESS 2. Maintain Contact - RETENTION 3. COMPLETION Make Positive Lifestyle Changes Whole family and community based solutions You alone can do it but... You CANNOT do it alone! The New Public Health 1987 Public Health & Asset Based Recovery 2011

5. Recovery Process 1.Make contact (e.g. Needle & Syringe Programmes) 2.Maintain contact (e.g. Stabilisation & medication) 3.Successfully complete treatment 4.Change Lifestyle 5.Change Identity 6.Prevent Inter Generational Transmission of Addiction

6. "The therapeutic value of one addict helping another 75 years on: more than 2 million members Wikipedia Rediscovering AA and Mutual Aid Recovery 1935; The Enlightenment (See Griffith Edwards On Lifelines FEAD) I cant but WE can Workers and Managers must be cured of Contempt prior to investigation

7. 3 elements in the treatment room? 1. Worker (You cant give away what you haven't got)2. Client/Patient Charteristics 3. Technology (how & what we talk about)

8. Treatment Workforce and Recovery Physician Heal Thyself Treat yourself first Experience recovery for yourself We want people to change their behaviour, will we change ours? Transformed people, transform people Your workforce are your biggest: Assets and Liabilities

9. Identifying and changing social Q. Who do you spend your time with in a typical week?

10. Challenging & Changing Lifestyles of Active Addiction

11. Encouraging & Promoting Lifestyles of Recovery

12. Deficit Based Approach Asset Based Approach WeaknessesStrengths Outside InInside Out Dependence on outside ProfessionalsDependence on each other Consumers of servicesPartners in provision of services Professionals non-judgemental training makes challenge difficult Challenge each other to do the right thing DisabilitiesAbilities, capacities, Assets ClientCitizen Passive victim of problemsActive participant in solutions

13. 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 – WORKING! 12 Step Mutual Aid (NA, CA, AA) SMART Recovery (CBT) Recovery Housing & Employment Recoverees as Experts

14. Why choose Abstinence as a basis for Recovery? turn the water off to mend the plumbing

15. I dont believe in ABSTINENCE! We are recovering via controlled drinking… …down to one beer a day now!

16. Dr Michael Taylor, Primary Care & Recovery Republic RECOVERY REPUBLIC York Street Surgery York Street

17. 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))

18. PPOs Carrying the Message BEFORE AFTER

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

20. Note All paths significant at p<.05. Goodness of Fit Index =.950. Mutual Aid Group Involvement Reduced Substance Use Active Coping General Friendship Quality Friends Support For Abstinence How & Why Mutual Aid works so well Keith Humphreys Motivation to change

21. 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 RECOVERYCOMMUNITYRECOVERYCOMMUNITY RECOVERYCOMMUNITYRECOVERYCOMMUNITY TREATMENT 5 ways to well being You alone can do it but you cant do it alone Treatment Plan Treatment Plan Recovery Plan Recovery Plan DOWNDOWN ACROSS TIMETIME TIMETIME Start Long term, in treatment population

22. Slide 22 Vertical and Horizontal Co-Production of Recovery New Presentations (including recyclers) - Down and Across RECOVERYCOMMUNITYRECOVERYCOMMUNITY RECOVERYCOMMUNITYRECOVERYCOMMUNITY TREATMENT Treatment Plan Treatment Plan Recovery Plan Recovery Plan DOWNDOWN ACROSS TIMETIME TIMETIME Start Long term, in treatment population Which bits do you do well alone? Which bits do you do in partnership with others?

23. 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.

24. Relapse = Warrior Down! http://www.whitebison.org

25. Vertical and Horizontal Co-Production of Recovery Already in Long term treatment – Up and Across RECOVERYCOMMUNITYRECOVERYCOMMUNITY RECOVERYCOMMUNITYRECOVERYCOMMUNITY TREATMENT Recovery Plan Recovery Plan ACROSS 12 Step facilitation to NA, CA, AA SMART Recovery Recovery Coaches/Champions Medication Assisted Recovery You alone can do it but you cant do it alone Treatment Plan Review Treatment Plan Review UPUP TIMETIME TIMETIME

26. DIP, TREATMENT, CARAT Frequent Flyer & Recycling Programme DIP CARATs TREATMENT How many? Who are they? Dual Diagnosis? PPOs?

27. Treatment Plan Review

28. Slide Three A Public Health Approach; Vertical and Horizontal Co-Production of Recovery RECOVERYCOMMUNITYRECOVERYCOMMUNITY RECOVERYCOMMUNITYRECOVERYCOMMUNITY DIRECT RECOVERY ORIENTED TREATMENT OPTIONS Detoxification Options: Community In Patient Detoxification Options: Community In Patient Introduce or switch to alternative medications (e.g. Buprenorphine/Lofexedine) Introduce or switch to alternative medications (e.g. Buprenorphine/Lofexedine) Intensive Day Programmes Graded Sober Living Accommodation Residential Rehabilitation Options: Houses on Hills Quasi Rehabs Hybrid Models Residential Rehabilitation Options: Houses on Hills Quasi Rehabs Hybrid Models

29. Slide Four A Public Health Approach; Vertical and Horizontal Co-Production of Recovery Medication Assisted Recovery TREATMENT Recovery Coaches Health Trainers Expert Patient Programmes Long term condition management programmes Mental Health Recovery Mark Gilman,Sunday, 13 April 2014 TIME=LONGTERMTIME=LONGTERM TIME=LONGTERMTIME=LONGTERM Long Term Maintenance Medication Service Start Medication Assisted Recovery Service Goals and Outcomes: Keep people alive and out of prison Reduce BBV transmission Overdose Prevention Crime Reduction Employment Training Education Quality of Life (QALYs) Health & Wellbeing Improvements Medication Assisted Recovery Service Goals and Outcomes: Keep people alive and out of prison Reduce BBV transmission Overdose Prevention Crime Reduction Employment Training Education Quality of Life (QALYs) Health & Wellbeing Improvements

30. Recovery Communities Risky and Ambitious? A life beyond your wildest dreams

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