recovery and recovery cities the social contagion of hope ... · valid bosnia & herzegovina 72...

Recovery and recovery citiesThe social contagion of hope and inclusion

Professor David Best

Sheffield Hallam University

Australian National University

Recovery is a personal journey within a social context

The manifestation of recovery is community-based

Definitions • Betty Ford; UKDPC (et al):

Sobriety, participation, global health

• Leamy et al (2011): CHIME• Connectedness

• Hope

• Identity

• Meaning

• Empowerment

• 58% of people with a lifetime substance use disorder achieve stable recovery

• 50-70% of people relapse in Year 1 after detox; 14% after Year 5

• 79% of people in stable recovery contribute to their community compared to 40% of people never addicted

RNS Objectives & Orientation

Measure

Plan

Engage | Connect HopeM⁴

Meaning, Mentor,

Monitor, Measure

Empowerment

Identit

y

The Engine of Change

Three key areas of clear evidence-based models for recovery:

• RECOVERY HOUSING

• MUTUAL AID

• PEER DELIVERED INTERVENTIONS • Peer models are successful because they provide the personal

direction, encouragement and role modelling necessary to initiate engagement and then to support ongoing participation

Recovery enablers -Humphreys and Lembke (2013)

Time in residence + meaningful activities to positive outcomes (FARR)

“I support recovery, as long as it’s not in my back yard”

• Public perceptions of addicts (Philips & Shaw, 2013)• 4 populations: smokers, obese people, active and recovering addicts

• The US population generally does not believe in recovery

• Addiction as an irreversible stain

Changes in work and study over the course of recovery

0

10

20

30

40

50

60

70

80

90

Restoredprofessional

license

Dropped outof school or

college

Got fired orsuspended

Frequentlymissed work

or school

Furtherededucation or

training

Got good jobevaluations

Lostoccupational

license

Steadilyemployed

Started ownbusiness

Early recovery

Sustained recovery

Stable recovery

Gender differences in recovery

Life In Recovery in the Balkans

Split by countries Details of participants• 190 (72.2%) male. 27.8% female

• High levels of polydrug use

• Mean onset age of illicit drug use was 15.5 years and the age of most recent drug use was 30.5 years

• 23.6% saw themselves as being 'in recovery'; 37.6% as 'recovered'; 17.9% as used to have a drug problem but don’t now, 10.6% in medication assisted recovery and 10.3% as another status

Frequency Percent Valid PercentValid Bosnia &

Herzegovina 72 27.4 27.4

Serbia123 46.8 46.8

Croatia53 20.2 20.2

Montenegro15 5.7 5.7

Total263 100.0 100.0

Sources of lifetime help-seeking

12-step 8.0%

PBRSS 9.1%

Resi Rehab, TC or detox 63.9%

Specialist out-patient treatment 53.2%

Other service (such as a church) 44.9%

Key comparisons with rest of European sample

Balkans (n=263) Other European countries

(n=217)

t, significance

Age of first drug use 15.5 15.9 10.9, ns

Age of last drug use 30.5 32.9 2.49, p<0.05

Age of first help seeking 24.1 25.9 2.45, p<0.05

Time since last problem drug

use (years)

7.2 5.8 2.23, p<0.05

Length of time in recovery

(years)

6.7 4.9 2.86, p<0.05

Age 37.1 38.1 1.13, ns

How could we, as a society, facilitate & promote recovery?

• Focus on beating stigma, discrimination and exclusion which represent significant barriers to recovery• Invest in meaningful jobs, stable housing, social

relationships• ‘Giving something back’

• Social connectedness and belonging are key

• A change of mindset in the society can promote sustained recovery• Contribute to the growth of community

recovery capital

• Recovery community Co-recovery

• Williams (1999): “changing places, settings, situations, locales and milieus that encompass the physical, psychological and social environments associated with treatment or healing” (Williams, 1999, p.2)

• Wilton and DeVerteuil (2006) describe a cluster of alcohol and drug treatment services in San Pedro, California as a ‘recovery landscape’ as a foundation of spaces and activities that promote recovery

Therapeutic landscapes

• Wilton and DeVerteuil: a social project that extends beyond the boundaries of addiction services into the community through the emergence of an enduring recovery community, in which a sense of fellowship is developed in the wider community

• Challenge stigma

• Change community recovery capital

Therapeutic landscapes (2)

Social Recovery

Capital

Collective Recovery Capital

Personal Recovery

Capital

Best and Laudet (2010)

• There is a strong and dynamic relationship between the three component parts of RC.

• The techniques in the model are intended to support the growth of RC by maximising the resources available to each individual, and based on the assumption that recovery is an intrinsically social process and one that needs not only personal commitment and determination but also the support and engagement of the social network and support system.

(Best, Irving, Collinson, Andersson & Edwards, 2016)

Ice Cream Cone Model

Funding by:

Innovating for

Improvement

Round 3 Project

What to link toAsset Based Community Development domains

MUTUAL AID GROUPS (MA)

RECREATION AND SPORT (R&S)

VOLUNTEERING, EDUCATION AND

EMPLOYMENT (VEE)

PEER AND RECOVERY COMMUNITY GROUPS

(PRCG)

Assets: recreation and sport

Assets: mutual aid groups

Assets: peer and recovery community groups

Assets: volunteering, education and employment

“We do that already”: Normal referral processes are ineffective

Alcoholic outpatients (n=20)

Standard 12-step referral (list of meetings & clinician

encouragement to attend)

Intensive referral (in-session phone call to active

12-step group member)

0% attendance rate

100% attendance rateSisson & Mallams (1981)

• Acute Assessment Unit at the Maudsley Hospital

• Low rates of meeting attendance while on ward

• RCT with three conditions:• Information only• Doctor referral • Peer support

Those in the assertive linkage condition:• More meeting attendance (AA, NA, CA) on ward • More meeting attendance in the 3 months after departure • Reduced substance use in the three months after departure

Manning et al (2012)

• The Family Connectors programme utilises the existing social capital of friends/family of the prisoners on the outside.

• These relationships then provide the basis for the restoration of bonding capital (resources within existing networks of the target individual) and the formation of bridging capital (resources outside the immediate network) and so decrease the gap between the prisoner and the community.

The KFC Programme

Strategy to enhance recovery: building an inclusive city

Different stakeholders working together

• City council

• Public & private organisations

• Criminal justice actors & treatment providers

• Family & friends

• Citizens

• People in recovery

Inclusive cities paper

Best & Colman (in review)

Central idea: no one should walk the recovery path alone. An inclusive citypromotes participation, inclusion, full and equal citizenship to all her citizens, also to those in recovery

Central aim: 1) challenge social exclusion at city level 2) make recovery visible, celebrate it and create a safe environment

supportive to recovery• “Recovery is contagious”

Beneficial for the person in recovery, as well as for the community as a whole• “The helper principle”

Radio Gaga

Recovery bike rideSerenity cafe

Jobs, Friends & Houses

San Patrignano

How to build inclusive cities?

For example in Ghent:

1. Bring several actors from different organisations responsible for housing, employment, social welfare,… together. Include people in recovery as well!

2. Make an overview of existing practices for people in recovery

3. Identify gaps

4. Define the city’s mission, vision statement, goals (short- term and long-term) and actions towards people in recovery

5. Monitor, evaluate and adapt!

Several promising examples

• Small actions or big actions (according tomindset & resources available)

The most important step however, is to bring it all together and to create partnerships

Where to next?

Not just for heroin and alcohol. This is a way of tackling the new spice issues in town centres and the links to hopelessness and homelessness

d.best@shu.ac.uk

charlotte.colman@ugent.be

Website (under construction):

https://charlottecolman1.wixsite.com/inclusivecities