Positive Social Networks & Recovering from Addiction

1. Positive Social Networks&Recovering from Addiction Mark Gilman, Strategic Recovery Lead, Public Health England Mark.gilman@phe.gov.uk

4. 5th Wave Public Health Asset Based Community Development ABCD Mutual Aid (AA, SMART)

5. Positive Social Network PHE Endorses BUT PHE does not endorse any MA ‘Brand’ Mutual Aid (MA) MA Brand X MA Brand Y MA Brand Z

6. What & Who are we talking about? “Addicts” & “Alcoholics” Heavy Users Binge Drinkers SOCIAL (“successful”) Drinkers and Users Abstainers

7. Drug dependency, “addiction” & “addicts” Alcohol dependency, “alcoholism” & “alcoholics”

8. Health Warnings & Clarifications • “Addiction” & “Alcoholism” • Not technically Twelve Step Facilitation as per manuals • Not just about 12 step fellowships • It is equally about SMART Recovery Mutual Aid • It is about getting people into a support network • Social relationships are a matter of life and death • Asset Based Community Development (ABCD)

9. Behaviours in Public Health Context • Smoking tobacco - COPD (e.g. Emphysema) • Eating too much bad stuff (sugar addiction?) – “Diabesity” obesity & type 2 diabetes • Not taking exercise • Drinking too much alcohol (how much is ‘too much’? UK, USA, Europe? • Smoking “skunk” type high potency cannabis • NPS (New Psychoactive Substances, ‘legal highs’) • Sniffing Cocaine and taking Ecstasy (UK ‘recreational’ drug use?) • “Addiction” to alcohol, benzodiazepines, opioids (heroin) and crack cocaine • Socially Isolating • Committing acquisitive crimes to raise funds to buy drugs • Contracting and transmitting BBVs

10. “The Perfect Storm of Addiction”&Inter Generational Transmission

11. Continuum of involvement with substances

12. What kind of substance problem? • Binge Drinker/User? • Heavy drinker/User? • “Alcoholic”? Alcohol “Addict”?

13. What do different types need to do?

14. Why choose Abstinence as a basis for Recovery…? “…because you have to turn the water off to mend the plumbing”

15. “Alcoholics” and Controlled Drinking “…down to one beer a day now!”

16. “Alcoholics” alone & thinking: “I’ll just drink at the weekend!” “I will only drink good red wine!”

17. Positive Social Networks • PHE supports the evidence for the powerful benefits of positive social networks in sustained recovery from addiction. • Different kinds of groups and approaches work for different people, as acknowledged in recent NICE guidance. • PHE does not recommend 12-step mutual aid above other evidence-based alternatives. • PHE is committed to promoting improved access to mutual aid for everyone who can benefit from it and we are in the process of developing a work stream to deliver this ambition. • There is no single route to recovery: the availability of a choice of options in recovery support, as in treatment, is fundamental to our vision.

18. Recovery History – the role of AA “I’d rather have a bottle in front of me than a frontal lobotomy!”

19. Gold Injections, Aversion Therapy, Eating lemons… and much worse in Nazi Germany

20. “I stood in the sunlight at last” “The icy intellectual mountain in whose shadow I had lived and shivered many years…” Spiritual awakening

21. Bio-Medical and Psychological Treatments +Positive Social Networks • Positive Social Network • Recovery Community Treatment PSYCHO BIO SOCIAL

22. Social relationships have big impact: comparative odds of decreased mortality Social relationships: Overall findings from this meta-analysis 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Social relationships: High vs. low social support contrasted Social relationships: Complex measures of social integration Smoking <15 cigarettes daily Smoking cessation: Cease vs. continue in patients with CHD Alcohol consumption: Abstinence vs. excessive drinking Flu vaccine: Pneumococcal vaccination in adults Social relationships have as great an impact on health outcomes as smoking cessation, and more than physical activity and issues to address obesity Cardiac rehabilitation (exercise) for patients with CHD Physical activity (controlling for adiposty) BMI: Lean vs. obese Drug treatment for hypertension in populations > 59 years Air pollution: low vs. high Holt-Lunstad J et al. PLoS Med. 2010;7:e1000316

23. Who Recovers? • Everyone CAN recover • Not everyone WILL recover • We don’t know WHO will recover • So, give everyone EVERY CHANCE

24. What does “Every Chance” look like?

25. I’m In Treatment but Socially Isolated? • I’m alive • I’m not in prison • I’m HIV free But, I’m alone…

26. Welcome to Recovery:a positive social network

27. Recovery does slowlywhat drink, drugs & medications do fast... ...changes perception of reality. Learning how to fit in To live life on life’s terms Free from addiction “Community as method” Recovery community a place where you learn how to live right, with other people... Free from fear…

28. CONNECT?Groups?Mutual Aid?Nah! I can do it on my own! “I'm not getting in that lifeboat me!” “Keep rowing people!”

29. From Bio-Medical Treatment and Psychological Support to Self Management and Self Care • Self Management • Self Care • Recovery Community Treatment

30. CONNECT(Five ways to wellbeing)

31. Getting Started? A Map… Presentation title - edit in Header and Footer

32. “Co-Production” of Recovery TREATMENT R E C O V E R Y C O M M U N I T Y Treatment Plan Recovery Plan 5 ways to well being “You alone can do it but you can’t do it alone” Co-Dependency? “You can check-out any time you like,But you can never leave! " Long term, in treatment population

33. Identifying and changing social networks Q. Who do you spend your time with in a typical week? Positive Pro-Recovery people IN Negative Anti-Recovery people OUT

34. “Crabs in a Barrel”

35. “There is a Solution we know How it Works” REDISCOVERING ALCOHOLICS ANONYMOUS POSITIVE SOCIAL NETWORK “You alone can do it but you cannot do it alone” “Ican’t but WE can”

36. Assertive Linkage to Mutual Aid • SMART Recovery UK • Twelve Step Facilitation UK • “You alone can do it but you cannot do it alone • “I cant but WE can” • "The therapeutic value of one “addict” helping another”

37. Social CapitalRobert D. Putnam (‘Bowling Alone’and ‘Better Together’) “The sense of mutuality that we feel for one another that expresses itself in trust and care…Your good being bound together with my good.” • Bonded Social Capital • (within) • Bridging Social Capital • (between)

38. Bridging Social Capital (between)“We are people who normally would not mix” AA Big Book

39. Recovery as social justice?

40. “I’d rather have a bottle in front of me than a frontal lobotomy!”

42. HUMBLE DOCTORS: “I CANT HELP YOU ROWLAND”, “SPIRITUS CONTRA SPIRITUM”

43. HUMBLE DOCTORS: “KEEP DOING WHAT YOURE DOING BILL!”

44. Public Health and Mutual Aid Alcoholics Anonymous (AA) Recovery since 1935 "The therapeutic value of one addict helping another” An Asset with “more than 2 million members” Wikipedia “I cant but WE can” “You alone can do it but you cannot do it alone”

45. Bruce Alexander: The Globalisation of Addiction – A Study in “Poverty of the Spirit”