Harm reduction and recovery

1. Harm reduction and recovery Sarah Vaile Recovery Cymru 02920 227 019 sarah@recoverycymru.org.uk www.recoverycymru.org.uk

2. Purposes and aims • Lots of talk about recovery • Collaboration is the key! • Crossed-wires? • Where are we at as a sector? • Different approaches to recovery focused treatment in Wales, England, Scotland…

3. Agree, Disagree, Don’t know Recovery = Abstinence

4. Agree, Disagree, Don’t know Recovery is just a new buzz word – it’s what we were doing all along!

5. Agree, Disagree, Don’t know Recovery is the opposite of harm reduction

6. Agree, Disagree, Don’t know The Recovery approach is not suitable for everyone

7. What are we talking about when we talk about ‘Recovery’? • Recovery for the individual • The Recovery Model for Treatment • Community-led recovery support

8. Recovery for the individual • A journey, process, experience • Self-defined • About quality of life • Reduction in problems • Different for each individual

9. The Recovery Model – why? • Waiting lists • Service User feedback – disempowerment, communication, treatment is ‘done to’ someone, lack of options for people seeking abstinence • ‘The methadone issue’ / ‘Script & nothing else’ • Perceived lack of psycho-social interventions • Treatment exits • The revolving door – aftercare / sustaining change

10. The Recovery Model – main messages • Recovery is a process that occurs in the community with others • Treatment may be one part of this process • Client ownership of the treatment process • Greater emphasis on long term goals and aspirations vs. symptom management • Valuing the contribution of professional expertise and the expertise of lived experience

11. The Recovery Model – main messages • Recovery Oriented Integrated Systems - services are not isolated pockets of care but should form a ‘greater whole’ • A range of treatment options and client choice • Planning for exit • Early re-intervention and re-linkage to treatment and recovery supports • Recovery communities

12. Community-led recovery support • Treatment – Aftercare – Community is not linear • The grass-roots peer-led recovery movement • Supports individuals on all stages of their journey, including throughout treatment • Independent life in the community

13. Implementing the Recovery Model: Concerns • Differences in the English, Scottish and Welsh approach • What does recovery mean for methadone prescribing, non-abstinence based recovery, client choice and treatment options • Perceived differences between alcohol and drug recovery • Perceived differences in options needed depending on the severity of problem • Philosophical differences re: abstinence

14. The Recovery Model and Harm Reduction • Are not separate or opposing paradigms! • Focus on individual journeys • You need to be alive to recover! • A recovery oriented treatment system needs a range of options for people on all stages of their journey and to support all client choices.

15. Medication Assisted Recovery: A ‘culture of prescribing’ • Focus on engagement in treatment and treatment retention… then what? • Disempowering prescribing practices • Long term prescribing with little / no choice to attempt reduction • Lack of psycho-social options available

16. Medication Assisted Recovery • Don’t throw the baby out with the bathwater • Medication can be a powerful tool • Options and choice • People’s needs and choices may change over time • We need to validate all recovery pathways: the recovery community is a big tent

17. The MARS Project, New York • Medication Assisted Recovery Support Project • Collaboration between the National Alliance of Methadone Advocates (NAMA) and the Albert Einstein College of Medicine • Opiate addiction has both medical and behavioural components. • Walter Ginter, Director • M-A-R advocate

18. The MARS Project, New York • “Methadone is not Recovery, Recovery is Recovery. Methadone is a pathway, a road, a tool. Recovery is a life and a particular way of living your life” • The methadone debates de-values the individual’s process of change and achievements • We should be focusing on a person’s life functioning.

19. Recovery Oriented Methadone Prescribing • A partnership prescribing plan • Psycho-social-spiritual options alongside prescribing • Focus on recovery capital and quality of life • Choice and encouragement: to attempt reduction (abstinence is not a dirty word!) • Validation of medication assisted recovery: challenging stigma

20. Harm Reduction and Recovery • Harm reduction is a necessary and critical part of a recovery oriented treatment system • The recovery community and harm reduction should work together • Recovery is about an individual’s quality of life, not about treatment philosophies • Policy, commissioning and system design need to support all elements of a recovery oriented treatment system and all recovery pathways!

21. The Welsh Approach Definition of Recovery for the individual: • “Recovery from alcohol and drug problems is a process of change over time that facilitates an individual to make positive choices and improve the quality of his or her life.” (2012) • Still a work in progress!

22. The Welsh Approach The definition will be used to support the development of: • A definition of a Welsh Recovery Oriented Treatment System • An audit criteria to measure recovery-focused practice

23. A shameless plug! “Embracing Recovery Training” In partnership with