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Positive Social Networks & Recovering from Addiction. Mark Gilman, Strategic Recovery Lead, Public Health England Mark.gilman@phe.gov.uk. 5 th Wave Public Health. Asset Based Community Development ABCD. Mutual Aid (AA, SMART). Positive Social Network. PHE Endorses. BUT

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positive social networks recovering from addiction

Positive Social Networks&Recovering from Addiction

Mark Gilman, Strategic Recovery Lead, Public Health England

Mark.gilman@phe.gov.uk

slide4

5th Wave Public Health

Asset Based

Community Development

ABCD

Mutual Aid

(AA, SMART)

slide5

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

what who are we talking about
What & Who are we talking about?

“Addicts” & “Alcoholics”

Heavy Users

Binge Drinkers

SOCIAL (“successful”) Drinkers and Users

Abstainers

slide7

Drug dependency, “addiction” & “addicts”

Alcohol dependency, “alcoholism” & “alcoholics”

health warnings clarifications
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)
behaviours in public health context
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
what kind of substance problem
What kind of substance problem?
  • Binge Drinker/User?
  • Heavy drinker/User?
  • “Alcoholic”? Alcohol “Addict”?
why choose abstinence as a basis for recovery
Why choose Abstinence as a basis for Recovery…?

“…because you have to turn the water off to mend the plumbing”

alcoholics and controlled drinking
“Alcoholics” and Controlled Drinking

“…down to one beer a day now!”

alcoholics alone thinking
“Alcoholics” alone & thinking:

“I’ll just drink at the weekend!”

“I will only drink good red wine!”

p ositive social networks
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.
slide18

Recovery History – the role of AA

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

slide20

“I stood in the sunlight at last”

“The icy intellectual mountain in whose shadow I had lived and shivered many years…”

Spiritual awakening

slide21

Bio-Medical and Psychological Treatments

+Positive Social Networks

  • Positive Social Network
  • Recovery Community

Treatment

PSYCHO

BIO

SOCIAL

social relationships have big impact comparative odds of decreased mortality
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

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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

who recovers
Who Recovers?
  • Everyone CAN recover
  • Not everyone WILL recover
  • We don’t know WHO will recover
  • So, give everyone EVERY CHANCE
but i m alone

I’m In Treatment but Socially Isolated?

  • I’m alive
  • I’m not in prison
  • I’m HIV free
But, I’m alone…
recovery does slowly what drink drugs medications do fast
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…

connect groups mutual aid nah i can do it on my own
CONNECT?Groups?Mutual Aid?Nah! I can do it on my own!

“I'm not getting in that lifeboat me!”

“Keep rowing people!”

slide29

From Bio-Medical Treatment and Psychological Support to Self Management and Self Care

  • Self Management
  • Self Care
  • Recovery Community

Treatment

getting started a map
Getting Started? A Map…

Presentation title - edit in Header and Footer

slide32

“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

identifying and changing social networks
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

slide35

“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”

slide36

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”
social capital robert d putnam bowling alone and better together
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)
bridging social capital between we are people who normally would not mix aa big book
Bridging Social Capital (between)“We are people who normally would not mix” AA Big Book
slide42

HUMBLE DOCTORS:

“I CANT HELP YOU ROWLAND”,

“SPIRITUS CONTRA SPIRITUM”

slide43

HUMBLE DOCTORS:

“KEEP DOING WHAT YOURE DOING BILL!”

slide44

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”

slide45

Bruce Alexander: The Globalisation of Addiction –

A Study in “Poverty of the Spirit”