Building RecoveryDIP Clinic

Mark Gilman

Strategic Recovery Lead

National Treatment Agency

Contents

2 very different types of

drug and alcohol use

A for “Addict”

Pareto Principle The Addicts20% use 80% + Responsible for 80% acquisitive crime

A Group BThe “Recreational” Users

•Bingers•Public Disorder

Who gets caught in DIP nets?

Drug and alcohol addicts offending driven by addictionOffenders who also use drugs

and alcohol. Offending not driven by substance use

What do we do with them?

Offenders who useNon-OCUs

Addicts who offendOCUs

Time limited, non medical intervention

Retained in treatment

DIP, TREATMENT, CARATFrequent Flyer & Recycling Programme

DIP

CARATs

TREATMENT

How many?Who are they?

Dual Diagnosis?PPOs?

Me, Myself and I – in treatment and alone

Social Isolation in TreatmentME

MYSELF

I

Why remodel treatment systems?

2010 drug strategy: Building Recovery (in Communities)

“Substitute prescribing continues to have a role to play in the treatment of heroin dependence...

(But...)

Its first step on the journey to recovery”

2010 drug strategy: Building Recovery (in Communities)

... supporting recovery from drug and alcohol dependence. 

puts more responsibility on individuals to seek help and overcome dependency

holistic approach...employment and housing

Recovery Communities

Community Treatment

Finding Recovery?

“Where do I find this recovery

stuff?”

"The therapeutic value of one addict helping

another”

75 years on:“more than 2

million members” Wikipedia

Rediscovering AA and Mutual Aid: 10/06/35; “The Enlightenment”

(See Griffith Edwards

On Lifeline’s FEAD)

“I cant but WE can”

Issue date: July 2007

NICE clinical guideline 51Developed by the National Collaborating Centre for Mental Health

Drug misuse

Psychosocial interventions

NICE Guidelines

“Staff should routinely provide people who misuse drugs with information about self-help groups.

These groups should normally be based on 12-step principles; for example, Narcotics Anonymous & Cocaine Anonymous. “

Note

All paths significant at p<.05. Goodness of Fit Index = .950.

Mutual Aid GroupInvolvement

Reduced Substance

Use

Active Coping

GeneralFriendship Quality

Friends’ SupportFor Abstinence

Psychological and Social changes via Mutual Aid Keith Humphreys

Motivation to change

Summary of What We Know (ref: Keith Humphreys)

12-step group participation significantly reduces drug and alcohol use.

12-step group involvement reduces ongoing health care costs.

Benefits of 12-step groups mediated both by psychological and social changes.

Identifying and changing social networks“You are who you spend time with”

The Lifestyle of Active Addiction

The Lifestyle of Recovery

Recovery as Emigration & Immigration

RECOVERY LAND

RECOVERY COMMUNITY

“Farewell Treatment.Thank You”

Big Ideas

SANITATION Asset Based Community Development

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 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

Node = a person

Line = a relationship between two people

“embedded”: the degree to which a person is connected within a network

more embedded = central

less embedded = periphery

CONNECTING & SOCIAL NETWORKS

CONNECTING & SOCIAL NETWORKS; Contagion, Connection, Homophily

• 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”)

PPOs Carrying the Message

BEFORE

AFTER

•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))

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

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, WORK

3. Give… Do something for someone else. Volunteer. Sponsor.

4. Keep Learning… Try something new. Become a student of recovery?

5. Take Notice… Be curious. Be present. ‘The Power of Now’.

Recovery Pioneers & Champions

“We are family!” Hard Wired to Attachment

“We may not need everybody but all of us need somebody”