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

Mutual aid and its facilitation

Steve Taylor, Alcohol & Drugs, PHE

10 April 2013

Why social networks matter

2 Mutual aid April 2013

Meta analysis: comparative odds of decreased mortality

Source: Holt-Lundstad et al 2010

Five ways to wellbeing


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)


Recovery Orientated Drug TreatmentWhat?

“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


NTA/PHE recovery resourceHelping 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…”


Who recovers?• Everyone CAN recover

• Not everyone WILL recover

• We don’t know WHO will recover

• So, give everyone EVERY a chance


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)


Mediators of effectivenessHow 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


Mediators of effectivenessHow 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

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 ThanOne Hundred Men Have Recovered From Alcoholism), after William Paley 1794

•Read

•Watch

•Learn

•GO!


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


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


http://www.mentalhealth.va.gov/providers/sud/selfhelp

Recovery Resourceshttp://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


http://www.nta.nhs.uk/recovery-resources.aspx

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

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