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”
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