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Slide 1
“WHAT'S THE POINT OF TREATMENT?”
Mark GilmanStrategic Recovery Lead
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“WHAT'S THE POINT OF TREATMENT?”
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Big IdeasSANITATION
Asset Based Community Development
A
B
C
D
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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
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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
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"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”
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3 elements in the treatment room?
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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
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Identifying and changing socialQ. Who do you spend your time with in a typical week?
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Challenging & Changing Lifestyles of Active Addiction
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Encouraging & Promoting Lifestyles of Recovery
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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
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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
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Why choose Abstinence as a basis for Recovery?
“turn the water off to mend the plumbing”
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“I don’t believe in ABSTINENCE!We are recovering via controlled drinking…
…down to one beer a day now!”
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Dr Michael Taylor, Primary Care & ‘Recovery Republic’
RECOVERY REPUBLICYork StreetSurgery
York Street
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•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))
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PPOs Carrying the Message
BEFORE
AFTER
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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...
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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
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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
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T
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E
StartStart
Long term, in treatment populationLong term, in treatment population
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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
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T
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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?
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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’.
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Relapse = “Warrior Down!” http://www.whitebison.org
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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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T
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DIP, TREATMENT, CARATFrequent Flyer & Recycling Programme
DIP
CARATs
TREATMENT
How many?Who are they?Dual Diagnosis?
PPOs?
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Treatment Plan Review
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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’
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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
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Recovery CommunitiesRisky and Ambitious?
“A life beyond your wildest dreams”
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“We are family!” Hard Wired to Attachment
“We may not need everybody but all of us need somebody”