Transcript Recovery Oriented Provision - What`s the point of treatment?

“WHAT'S THE POINT OF TREATMENT?”
Mark Gilman
Strategic Recovery Lead
Slide 1
“WHAT'S THE POINT OF TREATMENT?”
Reduce Crime
Reduce BBV Transmission
Initiate Long Term Recovery
Big Ideas
SANITATION
Asset Based Community Development
A
B
C
D
The New Public Health 1987
Public Health & Asset Based Recovery 2011
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!”
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
Rediscovering AA and Mutual Aid
Recovery 1935; “The Enlightenment”
"The therapeutic value of one
addict helping another”
(See Griffith Edwards
On Lifeline’s FEAD)
75 years on:
“more than 2
million
members”
Wikipedia
“I cant but WE can”
Workers and Managers must be cured of “Contempt prior to investigation”
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)
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
Identifying and changing social
Q. Who do you spend your time with in a typical week?
Challenging & Changing Lifestyles of Active Addiction
Encouraging & Promoting Lifestyles of Recovery
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:
Recovery:
Acute Short Term interventions
Long term process
“I” for Individual, Individualism
“We” as in Community, Mutualism
Medical & Clinical
Social & Communal
Risk Averse
Embraces Risk
Apathetic
Ambitious
Talking therapies
Activities – WORKING!
•Aftercare
•Day Programmes (CBT)
•12 Step Mutual Aid (NA, CA, AA)
•SMART Recovery (CBT)
Residential Treatment
Recovery Housing & Employment
Professionals as Experts
“Recoverees” as Experts
Why choose Abstinence as a basis for Recovery?
“turn the
water off to
mend the
plumbing”
“I don’t believe in ABSTINENCE!
We are recovering via controlled drinking…
…down
to one
beer a
day
now!”
Dr Michael Taylor, Primary Care &
Surgery
York Street
‘Recovery Republic’
RECOVERY REPUBLIC
York Street
•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))
PPOs Carrying the Message
AFTER
BEFORE
Recovery does slowly
what drink, drugs & medications 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...
How & Why Mutual Aid works so well
Keith Humphreys
Active Coping
Mutual Aid Group
Involvement
Motivation to
change
General
Friendship Quality
Friends’ Support
For Abstinence
Note
All paths significant at p<.05. Goodness of Fit Index = .950.
Reduced
Substance
Use
Vertical and Horizontal Co-Production of Recovery
New Presentations (including “recyclers”) - Down and Across
Start
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Recovery
Plan
TREATMENT
Treatment
Plan
D
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N
ACROSS
5 ways to well being
“You alone can do it but
you can’t do it alone”
T
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M
E
Increase
Successful
Completions
“Those who
successfully
complete
don't hang
around”
Long term, in treatment population
Vertical and Horizontal Co-Production of Recovery
New Presentations (including “recyclers”) - Down and Across
Start
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Slide 22
Recovery
Plan
TREATMENT
Treatment
Plan
D
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ACROSS
T
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•Which bits do you
do well alone?
•Which bits do you
do in partnership
with others?
Long term, in treatment population
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’.
Relapse = “Warrior Down!”
http://www.whitebison.org
Vertical and Horizontal Co-Production of Recovery
Already in Long term treatment – Up and Across
TREATMENT
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•12 Step facilitation to NA, CA, AA
•SMART Recovery
•Recovery Coaches/Champions
•Medication Assisted Recovery
“You alone can do it but
you can’t do it alone”
ACROSS
T
I
Recovery
Plan
U
P
Treatment
Plan
Review
M
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DIP, TREATMENT, CARAT
Frequent Flyer & Recycling Programme
How many?
Who are they?
Dual Diagnosis?
PPOs?
CARATs
DIP
TREATMENT
Treatment Plan Review
Slide Three
A Public Health Approach; Vertical and Horizontal Co-Production of Recovery
DIRECT RECOVERY ORIENTED TREATMENT OPTIONS
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Introduce or switch to alternative
medications
(e.g. Buprenorphine/Lofexedine)
Detoxification Options:
•Community
•In Patient
Intensive Day Programmes
Graded Sober Living Accommodation
Residential Rehabilitation
Options:
‘Houses on Hills’
‘Quasi Rehabs’
‘Hybrid Models’
Slide Four
A Public Health Approach; Vertical and Horizontal Co-Production of Recovery
Medication Assisted Recovery
Start
TREATMENT
T
I
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Long Term Maintenance Medication
Service
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
Mark Gilman,Saturday, 26 March 2016
E
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•Recovery Coaches
•Health Trainers
•Expert Patient Programmes
•Long term condition
management programmes
•Mental Health Recovery
Recovery Communities
Risky and Ambitious?
“A life beyond your wildest dreams”
“We are family!”
Hard Wired to Attachment
“We may not need everybody but all of us need somebody”