Fostering recovery: wider consideration and application

1. Fostering recovery: wider consideration and application Professor John Strang Director, National Addiction Centre (Kings College London; and South London and Maudsley NHS Foundation Trust)

2. Declarations • Thanks to UKDPC • Our individual and collective independence • No personal funding (apart from travel etc) • Special thanks to Professor Tom McLellan

3. My personal CV • I’m a doctor and a scientist. Seek grip, leverage. Reserve right to change opinion …. • My generation has been devastated – by addiction, and by associated hazards • I care greatly about bringing improved treatment and recovery to people affected by addiction problems • Community teams; maintenance; Christian rehab; therapeutic communities; heroin prescribing; overdose prevention; naloxone training; prison aftercare

4. Structure of talk • Background of UKDPC consensus group • Constructing the group • The task • The output – the consensus statement • Where that takes us

5. Structure of talk • Background of UKDPC consensus group • Constructing the group • The task • The output – the consensus statement • Where that takes us

6. The stimulus 1 • Polarization – extreme, artificial? • Confusion of purpose • Uncertainty about objective

7. Examples of the confusion • ‘Abstinence versus maintenance’ • ‘Parked’ in a ‘methadone parking lot’ • People on methadone never become ‘drug-free’ • Abstinence is ‘better’

8. The stimulus 2 • Clearer thinking in the field of: • Mental health recovery; • Pain recovery; • …… • ……

9. The stimulus 3 • The Betty Ford et al consensus project

11. opportunity? Opportunity for positive change “Recovery” ripe for consideration (possible lessons from mental health field) impressed by Betty Ford Foundation Consensus Group Opportunity of new drug strategies

12. Structure of talk • Background of UKDPC consensus group • Constructing the group • The task • The output – the consensus statement • Where that takes us

13. Rules and expectations • Respect other points of view • Explore common and differing perspectives • Search for extent and zones of consensus • Communicate and extend

14. The Consensus Group Invited group of 16 people from different backgrounds & perspectives across UK. Deliberate cross-section of: perspectives (users, families, practitioners, commissioners, researchers) types & philosophy of provision (rehab, substitute prescribing, GP care, support groups) disciplines (GP, psychiatry, psychology, nursing, management, layman) “Locked away” for 2 days Considered other relevant work: Betty Ford Foundation Consensus, Scottish Essential Care, TOPS “Validation” phase

15. The CV of the working group • Wide spread of helping professionals • Wide spread of orientations • Inclusive of maintenance • Inclusive of residential rehab • Inclusive of 12-step • Multiple overlap of histories as user, carer, healthcare worker, etc

16. Structure of talk • Background of UKDPC consensus group • Constructing the group • The task • The output – the consensus statement • Where that takes us

17. Key features of the process A focus on … the overarching vision (not the means of achieving it); identifying areas of agreement (while accepting some areas of disagreement may remain); the experience/perspective of the individuals in recovery and the diversity of these experiences.

18. A statement, not a definition It is: Statement of a working description of recovery … … from the harm, distress and life problems directly related to a person’s substance use Which we hope can: Reflect the lived experience of users and families Provide an organising vision for individual services and the treatment system as a whole Enable outcome measurement for research & accountability

19. Key features of the recovery process • Recovery is about building a satisfying and meaningful life, as defined by the person themselves, not simply about ceasing problem substance use. • Recovery involves the accrual of positive benefits as well as the reduction of harms. • Recovery includes a movement away from uncontrolled substance use and the associated problems towards health, wellbeing and participation in society. • Recovery is a process, not a single event, and may take time to achieve and effort to maintain.

20. Key features of the recovery process • The process of recovery and the time required will vary between individuals. It may be achieved without any formal external help or with different types of support and interventions. No ‘one size fits all’. • Aspirations and hope, both from the individual drug user, their families and those providing services and support, are vital to recovery. • Recovery must be voluntarily-sustained in order to be lasting, although it may sometimes be initiated or assisted by ‘coerced’ or ‘mandated’ interventions within the criminal justice system. • Control over substance use is a key part of recovery, but is not sufficient on its own. Positive health and well-being and participation in society are also central to recovery.

21. Key features of the recovery process • Control over substance use means a comfortable and sustained freedom from compulsion to use, which may require abstinence from the problem substance or all substances, but may also encompass consistently moderated use and abstinence supported by prescribed medication, peer groups and families. • Positive health and well-being encompasses both physical and mental good health as far as they may be attained for a person, as well as a satisfactory social environment. • Recovery embraces inclusion, or a re-entry into society, the improved self-identity that comes with a productive and meaningful role, and also the idea of ‘giving back’ to society and others, such as family members, who may have been adversely affected by the individual’s substance use. • Recovery-oriented services need to support the aspirations of each individual to assist individuals build recovery across all the above domains.

22. Structure of talk • Background of UKDPC consensus group • Constructing the group • The task • The output – the consensus statement • Where that takes us

23. Recovery statement The process of recovery is characterised by voluntarily sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society.

24. Recovery statement The process of recovery is characterised by voluntarily sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society.

25. Recovery statement The process of recovery is characterised by voluntarily sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society.

26. Recovery statement The process of recovery is characterised by voluntarily sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society.

27. Recovery statement The process of recovery is characterised by voluntarily sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society.

28. Recovery statement The process of recovery is characterised by voluntarily sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society.

29. UK Drug Policy Commission Consensus Group: a vision for recovery Recovery is a process, not a single event, and may take time to achieve and effort to maintain. The process and the time required will vary between individuals. Recovery requires control over substance use (although it is not sufficient on its own). This means a comfortable and sustained freedom from compulsion to use. For many people this may require abstinence from the problem substance or all substances, but for others it may mean abstinence supported by prescribed medication or consistently moderate use of some substances. Recovery must be voluntarily-sustained in order to be lasting, although it may sometimes be initiated or assisted by ‘coerced’ or ‘mandated’ interventions within the criminal justice system. The process of recovery from problematic substance use is characterised by Recovery may be associated with a number of different types of support and interventions or may occur without any formal external help: no ‘one size fits all’. Recovery requires aspirations and hope from the individual drug user, their family and those providing services and support. voluntarily-sustained control over substance use which maximises health and well-being, and participation in the rights, roles and responsibilities of society Recovery is about building a satisfying and meaningful life, as defined by the person themselves, and involves participation in the rights, roles and responsibilities of society. The word ‘rights’ is included here in recognition of the stigma that is often associated with problematic substance use and the discrimination users may experience and which may inhibit recovery. Recovery embraces inclusion, or a re-entry into society, and the improved self-identity that comes with a productive and meaningful role. For many people this is likely to include being able to participate fully in family life and undertake work in a paid or voluntary capacity. Recovery maximises health and well-being, encompassing both physical and mental good health as far as they may be attained for a person, as well as a satisfactory social environment. Recovery is about the accrual of positive benefits, not just reducing or removing harms caused by substance use. UK Drug Policy Commission: www.ukdpc.org.uk

30. Structure of talk • Background of UKDPC consensus group • Constructing the group • The task • The output – the consensus statement • Where that takes us

31. Where that takes us (1) • Treatment retention is not recovery • Abstinence is not recovery • ‘Medication-assisted recovery’ – different types of medication (and many more to come) • The power of the evidence-base of MMT/BMT maintenance; and the danger of complacency • Recovery importantly is also to do with positives • Foster aspirations – empower and enable individuals

32. Where that takes us (2) • More than just ‘bums on seats’ • More than just ‘clean piss in pots’ • Integrate more stimulated aspiration to achieve more (‘value added’; recovery) • The responsibility to move up a gear • The challenge – operationalise, implement • Demand an improvement agenda, driving quality care in all modalities

33. Thank you