Desistance, Recovery & Austerity

1. Desistance, Recovery & Austerity Mark Gilman

2. “Desistance” from crime is: • a process through which people cease and refrain from offending. • a process which is very similar to the journeys that ‘addicts’ and ‘alcoholics’ make from active addiction to recovery. • a change in identity and social networks. • about a job, a house and new friends. • a process that involves ending dependencies on professionally delivered services and becoming part of a positive social network.

3. Recovering from “addiction”: • a process through which people cease and refrain from addictive behaviours. • a process which is very similar to the journeys that persistent offenders make from being anti-social criminals to pro-social citizens • a change in identity and social networks. • about a job, a house and new friends. • a process that involves ending dependencies on professionally delivered services and becoming part of a positive social network.

4. Desisters and People in Recovery: “do not blame themselves for their problems but hold themselves responsible for the solution to their own problems.” ShaddMaruna ‘Making Good’ 2008 “You are not responsible for being down, but you are responsible for getting up”

5. Austerity & Public Service Reform in Greater Manchester (GM) 22bn 17bn • GM spends around £5bn more than our total tax contribution • Total tax take estimated at £17bn. Significant investment in growth. GM economy more resilient than most • Need to sustainably reduce £22bn public spending • Total spend has actually increased since 2009, despite the cuts • Proportions have changed – more on welfare benefits: costs of failure • New delivery models that move people towards self-reliance

6. 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

7. The process of moving towards self reliance (FOR THOSE WHO CAN MAKE IT!) • Positive Social Network • Mutual Aid • Recovery Community Treatment PSYCHO BIO SOCIAL

8. New ModelsMedical Treatment & Mutual Aid CHANGE THIS... Medical, Clinical Treatment Mutual Aid TO THIS... = +45 % extra capacity Medical, Clinical Treatment Mutual Aid

9. Alcoholics Anonymous produces same outcomes for 45% lower cost Over 3 years per-person treatment costs for AA group: 45 % lower than ‘professional’ treated groups with similar outcomes. Mutual Aid reduces on-going treatment costs Keith Humphreys, PhD Professor (Research) of Psychiatry and Behavioural Sciences Stanford Health Policy Associate Senior Policy Advisor at the White House ‘Circles of Recovery’ Cambridge University Press, 2003 Humphreys, K., & Moos, R. (1996). Reduced substance abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatric Services, 47, 709-713. Inflated to 2012 prices and converted to approximate pounds sterling.

10. WHAT WORKS IN RECOVERY?

11. Setting the standard for recovery: Physicians' Health ProgramsDuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS.J Subst Abuse Treat. 2009 Mar;36(2):159-71. doi: 10.1016/j.jsat.2008.01.004 • Abstinence-based • use of treatment programs selected for their excellence. • abstain from any use of alcohol or other drugs of abuse assessed by frequent random tests typically lasting for 5 years • close linkages to the 12-step programs of Alcoholics Anonymous and Narcotics Anonymous (and SMART?) • 78%of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring. • Q. what % should we expect of our “clients” and “patients”

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

13. 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)

14. Bridging Social Capital “We are people who normally would not mix” AA Big Book

15. Bruce Alexander: The Globalisation of Addiction – “Poverty of the Spirit”

16. Spiritual Solutions NOT Religiosity

17. “Alcoholics” alone & thinking: “I’ll just drink real ale”! “I will only drink good red wine!”