Positive Social Networks&

Recovering from Addiction

Mark Gilman, Strategic Recovery Lead, Public Health England

Mark.gilman@phe.gov.uk

5th Wave Public HealthAsset Based

Community DevelopmentABCD

Mutual Aid(AA, SMART)

Positive Social Network

Mutual Aid (MA)

MA Brand X

MA Brand Y

MA Brand Z

PHE Endorses

BUTPHE does not endorse any

MA ‘Brand’

6

What & Who are we talking about?

Abstainers

Binge Drinkers

SOCIAL (“successful”) Drinkers and Users

Heavy Users

“Addicts” & “Alcoholics”

Drug dependency, “addiction” & “addicts”Alcohol dependency, “alcoholism” & “alcoholics”

Health Warnings & Clarifications

• “Addiction” & “Alcoholism”• Not technically Twelve Step Facilitation as per

manuals• Not just about 12 step fellowships• It is equally about SMART Recovery Mutual Aid• It is about getting people into a support network• Social relationships are a matter of life and death• Asset Based Community Development (ABCD)

Behaviours in Public Health Context

• Smoking tobacco - COPD (e.g. Emphysema)• Eating too much bad stuff (sugar addiction?) – “Diabesity” obesity &

type 2 diabetes• Not taking exercise• Drinking too much alcohol (how much is ‘too much’? UK, USA, Europe?• Smoking “skunk” type high potency cannabis• NPS (New Psychoactive Substances, ‘legal highs’) • Sniffing Cocaine and taking Ecstasy (UK ‘recreational’ drug use?)• “Addiction” to alcohol, benzodiazepines, opioids (heroin) and crack

cocaine• Socially Isolating • Committing acquisitive crimes to raise funds to buy drugs• Contracting and transmitting BBVs

“The Perfect Storm of Addiction”&

Inter Generational Transmission

Genetic Predispositio

n

Childhood ‘Trauma’

Early Access to drink and

drugs

Continuum of involvement with substances

Occasional Use

• e.g. Drink Driving

Harmful Use

• Physical Dependency

Overwhelming involvement

• “Addiction”

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

Why choose Abstinence as a basis for Recovery…?

“…because you have to turn the water off to mend the plumbing”

“Alcoholics” and Controlled Drinking

“…down to one beer a day now!”

“Alcoholics” alone & thinking:“I’ll just drink at the

weekend!”“I will only drink good red wine!”

Positive Social Networks• PHE supports the evidence for the powerful benefits of positive social

networks in sustained recovery from addiction. • Different kinds of groups and approaches work for different people, as

acknowledged in recent NICE guidance. • PHE does not recommend 12-step mutual aid above other evidence-based

alternatives. • PHE is committed to promoting improved access to mutual aid for

everyone who can benefit from it and we are in the process of developing a work stream to deliver this ambition.

• There is no single route to recovery: the availability of a choice of options in recovery support, as in treatment, is fundamental to our vision.

“I’d rather have a bottle in front of me than a frontal lobotomy!”

Recovery History – the role of AA

Gold Injections, Aversion Therapy, Eating lemons… and much worse in Nazi Germany

“The icy intellectual mountain in whose shadow I had lived and shivered many years…”

“I stood in the sunlight at last”

Spiritual awakening

• 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

Who Recovers?

1. Everyone CAN recover2. Not everyone WILL recover3. We don’t know WHO will recover4. So, give everyone EVERY CHANCE

What does “Every Chance” look like?

Psychotherapeutic

Social NetworksSocial

Relationships

Bio Medical

I’m In Treatment but Socially Isolated?

• But, I’m alone…

• I’m alive

• I’m not in prison

• I’m HIV free

Welcome to Recovery:a positive social network

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

“Community as method”

Recovery community a place where you learn how to live

right, with other people...

Free from fear…

CONNECT?Groups?

Mutual Aid?Nah! I can do it on my own!

“I'm not getting in that lifeboat me!”

“Keep rowing people!”

• Self Management

• Self Care

• Recovery Community

Treatment

From Bio-Medical Treatment and Psychological Support to Self Management

and Self Care

CONNECT(Five ways to wellbeing)

Getting Started? A Map…TOPIC ACTION SCORE 5=High 1=Low

5 4 3 2 1

Connect •SMART RECOVERY•AA, NA, CA, OA...•Weight Watchers•Stop Smoking Groups•Peer Led Groups

Be Active •Exercise

Give •Volunteering•Community Involvement

Keep Learning •Further Education•Hobbies

Take Notice •Mindfulness•Spiritual ActivityPresentation title - edit in Header and Footer

“Co-Production” of Recovery

R ECOVERY

COMMUNITY

TREATMENT

5 ways to well being

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

TreatmentPlan

Recovery Plan

Long term, in treatment population

Co-Dependency?

“You can check-out any time you like,But you can never leave! "

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

“Crabs in a Barrel”

“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”

Social CapitalRobert D. Putnam (‘Bowling Alone’ and ‘Better Together’)

“The sense of mutuality that we feel for one another that expresses itself in trust and care…Your good being bound together with my good.”

• Bonded Social Capital • (within)

• Bridging Social Capital • (between)

Bridging Social Capital (between)“We are people who normally would not mix” AA Big Book

Recovery as social justice?

“I’d rather have a bottle in front of me than a frontal lobotomy!”

HUMBLE DOCTORS: “I CANT HELP YOU ROWLAND”,

“SPIRITUS CONTRA SPIRITUM”

HUMBLE DOCTORS:

“KEEP DOING WHAT YOURE DOING BILL!”

"The therapeutic value of one addict helping another”

An Asset with

“more than 2 million

members” Wikipedia

Public Health and Mutual AidAlcoholics Anonymous (AA) Recovery since 1935

“I cant but WE can”

“You alone can do it but you cannot do it

alone”

Bruce Alexander: The Globalisation of Addiction –

A Study in “Poverty of the Spirit”