Mark Gilman - Public Health England
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Transcript of Mark Gilman - Public Health England
Public HealthRecovery and Families
Mark GilmanStrategic Recovery LeadPublic Health England
Health Warnings & Clarifications“Addiction” & “Alcoholism”
• Not just about 12 step fellowships
• It is equally about SMART Recovery Mutual Aid
• It is about getting people into a support network
• Al Anon and Famanon
• Social relationships are a matter of life and death
• Asset Based Community Development (ABCD)
• 5th Wave Public Health
Some Addictive Behaviours in Public Health Context
• Smoking tobacco - COPD (e.g. Emphysema)
• Eating too much bad stuff (sugar addiction?) – “Diabesity” obesity & type 2 diabetes
• Drinking too much alcohol (how much is ‘too much’? UK, USA, Europe?)
• Smoking “skunk” type high potency cannabis
• NPS (Novel Psychoactive Substances, ‘legal highs’)
• “Addiction” to alcohol, benzodiazepines, opioids (heroin) and crack cocaine
• Socially Isolating
What’s the problem in your family?
Abstainers
Binge Drinker/User
SOCIAL Drinkers and Users
Heavy User
“Addicts” “Alcoholics”
What is the level of loved one’s use?
Occasional Use
Recreational Use
Binge Use
• e.g. Drink Driving
• e.g. Fatal Overdose
Continued
Harmful Use
• Physical problems
• Dependency
Overwhelming involvement
• “Addiction”• “Alcoholism”
Features of their involvement: bio-psycho-social
Psychological
Social
Biological
What kind of substance problem? Binge Drinker/User?
Heavy drinker/User?
“Alcoholic”? Alcohol “Addict”?
What do different types need to do?Bingers Get a different hobby
Heavy Users Control your drinkingKeep a drink diary
“Alcoholics”“Addicts”
Stop & Stay Stopped
Abstinence as a basis for Recovery from Addiction?
“…because you have to turn the water off to mend the plumbing”
“Alcoholics” and “Addicts” Controlled Drinking/Recreational Use?
“…down to one beer a day now!”
Right! I’m In Treatment but Socially Isolated?
• But, I’m alone…
• I’m alive
• I’m not in prison
• I’m HIV free
“Alcoholics” & “Addicts” alone & thinking:
“I’ll just buy a bag on pay day!”
“I will only drink good red wine!”
CONNECT?Groups?
Mutual Aid?Nah! I can do it on my own!
“I'm not getting in that lifeboat me!”
“Keep rowing people!”
• Positive Social Network
• Recovery Community
Treatment
Bio-Medical and Psychological Treatments
+ Positive Social Networks
BIO PSYCHO SOCIAL
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 have big impact:
comparative odds of decreased mortality
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
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
Social relationships have as great an impact on health outcomes as smoking
cessation, and more than physical activity and issues to address obesity
Positive Social Network
Mutual Aid (MA)
MA Brand X
MA Brand Y
MA Brand Z
PHE Endorses
BUTPHE does not endorse
any MA ‘Brand’
“There is a Solution we know
How it Works”
“I can’t but
WE can”
“You alone can
do it but you cannot do it
alone”
REDISCOVERINGALCOHOLICS ANONYMOUS POSITIVESOCIALNETWORK
Assertive Linkage to Mutual Aid
• SMART Recovery UK
• Twelve Step Facilitation UK
• “You alone can do it but you cannot do it alone
• “I cant but WE can”
• "The therapeutic value of one “addict” helping another”
“None of these guys are staying sober!” “But you are Bill!” (Al Anon is born)
AL ANON MUTUAL AID FOR FAMILIES AND FRIENDS
'When Love is Not Enough' "Our hearts do not need logic, they can love and forgive and accept that which our minds
cannot comprehend. Hearts understand in ways our minds cannot"
Lois Wilson, Founder of Al Anon
Identifying and changing social networksQ. Who do you spend your time with in a typical week?
Positive Pro-
Recovery people IN
NegativeAnti-
Recovery people OUT
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 addiction
Free from fear
“Community as method”
Recovery community a place where you learn how to live
right, with other people...
Al Anon & Famanon
‘Goodbye, Mr. Wonderful’ (Chris McCully 2004)
“Any fool can give up for a week or a month. For recovery to last, it has all got to change…are
you prepared to undertake all the changes another persons recovery might mean?”
“I preferred you when you were…”
Dear Chris, page 71…
Benefits of Family Involvement
Participation by family members is associated with better treatment compliance and outcome.
Family members gain a clearer understanding of recovery.
Family members and the person in recovery understand their respective roles and goals.
Family members and the person in recovery get support in the recovery process.
Al Anon & Famanon