slide 1 what's the point of treatment? mark gilman strategic recovery lead

Slide 1

“WHAT'S THE POINT OF TREATMENT?”

Mark GilmanStrategic Recovery Lead

“WHAT'S THE POINT OF TREATMENT?”

Big IdeasSANITATION

Asset Based Community Development

A

B

C

D

1. Make Contact - ACCESS

2. Maintain Contact - RETENTION

3. COMPLETION

Make Positive Lifestyle Changes

Whole family and community based solutions

“You alone can do it but...

You CANNOT do it alone!”

The New Public Health 1987

Public Health & Asset Based Recovery 2011

Recovery Process1. Make contact (e.g. Needle & Syringe Programmes)

2. Maintain contact (e.g. Stabilisation & medication)

3. Successfully complete treatment

4. Change Lifestyle

5. Change Identity

6. Prevent Inter Generational Transmission of Addiction

"The therapeutic value of one addict helping another”

75 years on:“more than 2

million members”

Wikipedia

Rediscovering AA and Mutual Aid Recovery 1935; “The Enlightenment”

(See Griffith Edwards

On Lifeline’s FEAD)

“I cant but WE can”

Workers and Managers must be cured of “Contempt prior to investigation”

3 elements in the treatment room?

Treatment Workforce and Recovery

•Physician Heal Thyself

•Treat yourself first

•Experience recovery for yourself

•We want people to change their behaviour, will we change ours?

•Transformed people, transform people

•Your workforce are your biggest: Assets and Liabilities

Identifying and changing socialQ. Who do you spend your time with in a typical week?

Challenging & Changing Lifestyles of Active Addiction

Encouraging & Promoting Lifestyles of Recovery

Deficit Based Approach Asset Based Approach

Weaknesses Strengths

Outside In Inside Out

Dependence on outside Professionals Dependence on each other

Consumers of services Partners in provision of services

Professionals non-judgemental training makes challenge difficult

Challenge each other to “do the right thing”

Disabilities Abilities, capacities, Assets

Client Citizen

Passive victim of problems Active participant in solutions

Treatment and Recovery: Content, Themes & Characteristics

Treatment:Acute Short Term interventions

“I” for Individual, Individualism

Medical & Clinical

Risk Averse

Apathetic

Talking therapies

•Aftercare•Day Programmes (CBT)

Residential Treatment

Professionals as Experts

Recovery:Long term process

“We” as in Community, Mutualism

Social & Communal

Embraces Risk

Ambitious

Activities – WORKING!

•12 Step Mutual Aid (NA, CA, AA)•SMART Recovery (CBT)

Recovery Housing & Employment

“Recoverees” as Experts

Why choose Abstinence as a basis for Recovery?

“turn the water off to mend the plumbing”

“I don’t believe in ABSTINENCE!We are recovering via controlled drinking…

…down to one beer a day now!”

Dr Michael Taylor, Primary Care & ‘Recovery Republic’

RECOVERY REPUBLICYork StreetSurgery

York Street

•Creating Recovery Communities

•Changing Social Networks

•Organising Recovery Communities

“The addition of just one abstinent person to a social network increased the probability

of abstinence for the next year by 27% Litt et al – “Changing network support for drinking” (2009, (p230))

PPOs Carrying the Message

BEFORE

AFTER

Recovery does slowly what drink, drugs & medications do fast...

...changes perception of reality.

Learning how to fit in

To live life on life’s terms

Free from fear

Free from addiction

“Community as method”

Recovery community a place where you learn how

to live right, with other people...

Note

All paths significant at p<.05. Goodness of Fit Index = .950.

Mutual Aid GroupInvolvement

Reduced Substance

Use

Active Coping

GeneralFriendship Quality

Friends’ SupportFor Abstinence

How & Why Mutual Aid works so well Keith Humphreys

Motivation to change

Vertical and Horizontal Co-Production of Recovery New Presentations (including “recyclers”) - Down and Across

Increase Successful Completions

“Those who successfully

complete don't hang

around”

R ECOVERY

COMMUNITY

R ECOVERY

COMMUNITY

TREATMENTTREATMENT

5 ways to well being

“You alone can do it but you can’t do it alone”

TreatmentPlanTreatmentPlan

Recovery PlanRecovery Plan

DOWN

ACROSS

T

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M

E

T

I

M

E

StartStart

Long term, in treatment populationLong term, in treatment population

Slide 22

Vertical and Horizontal Co-Production of Recovery New Presentations (including “recyclers”) - Down and Across

R ECOVERY

COMMUNITY

R ECOVERY

COMMUNITY

TREATMENTTREATMENT

TreatmentPlanTreatmentPlan

Recovery PlanRecovery Plan

DOWN

ACROSS

T

I

M

E

T

I

M

E

StartStart

Long term, in treatment populationLong term, in treatment population

•Which bits do you do well alone?

•Which bits do you do in partnership with others?

5 ways to well being in Recovery

1. Connect… With people around you. Go to meetings (AA, NA, CA, SMART)

2. Be Active…do something, go for a walk, exercise, do anything.

3. Give… Do something for someone else. Volunteer.

4. Keep Learning… Try something new. Become a student of recovery?

5. Take Notice… Be curious. Be present. ‘The Power of Now’.

Relapse = “Warrior Down!” http://www.whitebison.org

Vertical and Horizontal Co-Production of Recovery Already in Long term treatment – Up and Across

R ECOVERY

COMMUNITY

R ECOVERY

COMMUNITY

TREATMENTTREATMENT

Recovery PlanRecovery Plan

ACROSS

•12 Step facilitation to NA, CA, AA•SMART Recovery•Recovery Coaches/Champions•Medication Assisted Recovery

“You alone can do it but you can’t do it alone”

TreatmentPlan Review

TreatmentPlan Review

UP

T

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E

T

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DIP, TREATMENT, CARATFrequent Flyer & Recycling Programme

DIP

CARATs

TREATMENT

How many?Who are they?Dual Diagnosis?

PPOs?

Treatment Plan Review

Slide ThreeA Public Health Approach; Vertical and Horizontal Co-Production of Recovery

R ECOVERY

COMMUNITY

R ECOVERY

COMMUNITY

DIRECT RECOVERY ORIENTED TREATMENT OPTIONSDIRECT RECOVERY ORIENTED TREATMENT OPTIONS

Detoxification Options:•Community•In Patient

Detoxification Options:•Community•In Patient

Introduce or switch to alternative medications(e.g. Buprenorphine/Lofexedine)

Introduce or switch to alternative medications(e.g. Buprenorphine/Lofexedine)

Intensive Day ProgrammesIntensive Day Programmes

Graded Sober Living AccommodationGraded Sober Living Accommodation

Residential Rehabilitation Options:‘Houses on Hills’‘Quasi Rehabs’‘Hybrid Models’

Residential Rehabilitation Options:‘Houses on Hills’‘Quasi Rehabs’‘Hybrid Models’

Slide FourA Public Health Approach; Vertical and Horizontal Co-Production of Recovery

Medication Assisted Recovery

TREATMENTTREATMENT

•Recovery Coaches•Health Trainers•Expert Patient Programmes•Long term condition management programmes•Mental Health Recovery

Mark Gilman,Monday 10 April 2023

T

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=

LONG

TERM

T

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=

LONG

TERM

Long Term Maintenance Medication Service

Long Term Maintenance Medication Service

StartStart

Medication Assisted Recovery Service Goals and Outcomes:

“Keep people alive and out of prison”•Reduce BBV transmission

•Overdose Prevention•Crime Reduction

•Employment•Training

•Education•Quality of Life (QALYs)

•Health & Wellbeing Improvements

Medication Assisted Recovery Service Goals and Outcomes:

“Keep people alive and out of prison”•Reduce BBV transmission

•Overdose Prevention•Crime Reduction

•Employment•Training

•Education•Quality of Life (QALYs)

•Health & Wellbeing Improvements

Recovery CommunitiesRisky and Ambitious?

“A life beyond your wildest dreams”

“We are family!” Hard Wired to Attachment

“We may not need everybody but all of us need somebody”