STRENGTHS-BASED APPROACHES TO BUILDING

RECOVERYPristupi za izgradnju oporavka bazirani

na jakostima

Michael Edwards

Sheffield Hallam University

„Recovery from substance dependence- Shift in drug policy and practice 3“"Oporavak od ovisnosti - preokret u politikama i praksi 3"

Areas for discussionOblasti za diskusiju

1.What do we know about recovery?

1.Šta znamo o oporavku?

2.Recovery Capital

2.Kapital za oporavak

3.Measuring recovery capital: The ARC and the REC-CAP

3.Mjerenje kapitala za oporavak: ARC i REC-CAP

4.The 3-stage model: Assertive Linkage and Community Connectors

4.Model od 3 stadija: Asertivno povezivanje i Konektori u zajednici

5.A model for change: The Restore-Recover-Reintegrate Gear System

5. Model za promjenu:Obnovi-Oporavi-Reintegriraj

SECTION 1: WHAT DO WE KNOW ABOUT RECOVERY?1.ŠTA ZNAMO O OPORAVKU?

Key writers and experts in this areaKljučni pisci i eksperti iz ove oblasti

• William White

• Bruce Alexander

• Keith Humphreys

• John Kelly

• Alexandre Laudet

• Gabor Mate

• Shadd Maruna

• David Best

Addiction Onset

Help Seeking

Full Sustained Remission (1

year abstinent)

Relapse Risk drops below

15%

4-5 years 8 years 5 years

Self-initiated

cessation attempts

4-5 Treatment episodes/mutual-

help

Continuing care/

mutual-help

For more severely dependent individuals… course of dependence and achievement of stable

recovery can take a long time…

60% of individuals

with addiction will achieve full

sustained remission

(White, 2013)

60% of individuals

with addiction will achieve full

sustained remission

(White, 2013)

Opportunity for earlier detection through

screening in non-specialty settings like

primary care/ED

Opportunity for earlier detection through

screening in non-specialty settings like

primary care/ED

Definitions

• Betty Ford; UKDPC (et al): Sobriety, participation, global health /trijeznost, sudjelovanje,globalno zdravlje

• Deegan (1998)• Leamy et al (2011): CHIME

– Connectedness -Povezanost– Hope -Nada

– Identity -Identitet– Meaning -Smisao– Empowerment -Osnaživanje

Recovery enablers - Humphreys and Lembke (2013)

Three key areas of clear evidence-based models for recovery: Tri ključne oblasti neupitnih modela za oporavak zasnovanih na dokazima•RECOVERY HOUSING Stanovanje i oporavak•PROGRAMS THAT FACILITATE 12-STEP MUTUAL AID GROUP ENGAGEMENT- programi koji koriste grupe samopomoći 12 koraka•PROGRAMS THAT EXPAND PEER DELIVERED INTERVENTIONS IN PROFESSIONAL SYSTEMS-programi koji proširuju intervencije od strane oporavljenih ovisnika u prof sistem

– Peer models are successful because they provide the personal direction, encouragement and role modelling necessary to initiate engagement and then to support ongoing participation

– Peer modeli su uspješni jer pružaju lične smjernice, ohrabrivanje i primjere potrebne za pokretanje angažmana, a onda i da bi podržali kontinuirano sudjelovanje

Litt et al (2007, 2009)• Post-alcohol detox • Clients randomised to aftercare as usual or Network Support Klijenti

upućeni na uobičajeni post tretman ili na podršku mreže• Those randomised to Network Support had a 27% reduction in chances of

alcohol relapse in the next year• Osobe upućene na mrežu su imale 27% manje čanse za relaps u slijedećoj

godini

• This is assertive linkage Ovo je asertivno povezivanje • Illustrates power of mutual aid and mentor role • Pokazuje snagu uzajamne pomoći i uloge mentora

Recovery studies in Birmingham and Glasgow (Best et al, 2011a; Best et al, 2011b)

Studij Oporavka u Birmingemu i Glazgovu

What was beneficial? Šta je korisno?

–More time spent with other people in recovery–Provoditi više vremena sa osobama u oporavku

–More time in the last week spent in meaningful activities:–U poslijednjoj sedmici više vremena provedenog u smislenim aktivnostima:

• Childcare Briga o djeci

• Engaging in community groups Uključivanje u grupe u zajednici

• Volunteering Volontiranje

• Education or training Edukacija ili trening

• Employment Zaposlenje

SECTION 2: RECOVERY CAPITAL2.KAPITAL ZA OPORAVAK

What is Recovery Capital?Šta je kapital za oporavak?

Granfield and Cloud (2008) define recovery capital as:Granfield i Cloud definiraju kapital za oporavak kao:

“the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from AOD [alcohol and other drug] problems”.

“širinu i dubinu unutrašnjih i spoljašnjih resursa potrebnih za pokretanje i održavanje procesa oporavka od ADD [alkohola i drugih droga]".

White and Cloud (2008): Stable recovery best predicted on the basis of recovery assets not pathologies

Best and Laudet (2010)

Therapeutic landscapes Terapeutska okruženja

• 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)

• Williams (1999):“Promjena mjesta, okolnosti, situacija, prostora i miljea koji obuhvataju fizičko, psihološko i socijalno okruženje povezano sa tretmanom ili iscjeljenjem"

• 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

• Wilton i DeVerteuil (2006) opisuju skup tretmana za liječenje od ovisnosti o alkoholu i drogama u San Pedru, Kalifornija kao "pejzaž oporavka" kao osnovu prostora i aktivnosti koji promovišu oporavak

Therapeutic landscapes (2) Terapeutska okruženja

• 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

• Wilton i DeVerteuil: društveni projekat koji se proteže izvan granica usluga za rješavanje ovisnosti u zajednici kroz izgradnju stabilne zajednice za oporavak, u kojoj se razvija osjećaj zajedništva u širem društvu

• Challenge stigma Izazvati stigmu• Change community recovery capital

• Promijeniti kapital za oporavak zajednice

Social Identity Model of Recovery

Recovery capital: A cone with sprinkles

SECTION 3: MEASURING RECOVERY CAPITAL: THE ARC AND THE REC-CAP3.MJERENJE KAPITALA ZA OPORAVAK: ARC I REC-CAP

Assessment of Recovery Capital (ARC) properties

Procjena kapitala za oporavak• Good predictor of quality of life • Dobro predviđa kvalitet života• Strong reliability and internal properties• Veliki nivo odgovornosti i unutrašnja svojstva• Can be used to complement traditional (pathology-based) measures • Može se koristiti za dopunu tradicionalnih mjera (baziranih na patologiji)• Has been translated into six languages• Prevedena je na šest jezika

• Used in both clinical and research settings• Koristi se u kliničkim i u istraživačkim okruženjima• But... needs to be embedded in clinical contexts• Ali ... treba biti ugrađen u kliničke kontekste

REC-CAP rationale • Use as part of a recovery and treatment review process • Koristi se kao dio postupka pregleda oporavka i liječenja• Short assessment of overall functioning - that is linked to Treatment

Outcome Profile• Kratka procjena cjelokupnog funkcioniranja - koja je povezana s profilom

rezulta tretmana

• Provides an overall client profile • Pruža cjelokupni profil klijenta• Provide a wellbeing measure that covers the post-acute period • Pruža mjeru dobrobiti koja pokriva post-akutno razdoblje• Links to recovery care planning

Povezana je sa planiranjem oporavka

So what is the REC-CAP based on?Na čemu se zasniva REC-CAP?

• Treatment Outcome Profile (Marsden et al, 2008)• Maudsley Addiction Profile (Marsden et al, 1998)• Assessment of Recovery Capital (Groshkova, Best and White, 2012)• Recovery Group Participation Scale (Groshkova, Best and White, 2011)• Support Scale (Haslam et al, 2005)• Commitment to Sobriety Scale (Kelly and Greene, 2014)

What is the underlying model of recovery? Koji je osnovni model oporavka?

ADDRESSING ONGOING BARRIERS ADRESIRANJE AKTUELNIH PREPREKA•2 categories

– unmet and ongoing support and treatment needs

– potrebe za tretmanom koje još nisu adresirane i koje su tekuće

– acute wellbeing problems (offending, use, injecting, crime, housing, physical and mental health)

– aktutni problemi opšteg blagostanja (činjenje krivičnih djela, upotreba, ubrizgavanje, kriminal, stanovanje, fizičko i mentalno zdravlje)

IDENTIFYING AND BUILDING ON STRENGTHSIDENTIFIKACIJA I IZGRADNJA NA PREDNOSTIMA

•Personal recovery capital•Lični kapital za oporavak

•Social recovery capital •Društveni kapital za oporavak

•Community recovery capital•Kapital za oporavak zajednice

•Feelings of wellbeing• Osjećaj blagostanja

•These are both resources and means of addressing other problems•To su također resursi i sredstva za rješavanje drugih problema

Based on the Treatment Process Model (Simpson,

2004)• The key initial tasks are building motivation and engagement and

addressing acute problems • Ključni početni zadaci su izgradnja motivacije i angažovanja kao i rješavanje

akutnih problema

• Addiction is a relapsing condition and so we need to be aware of re-emerging problems before we address strength and resource building

• Ovisnost je recidivirajuće stanje i zato treba da budemo svjesni problema koji se ponovo pojavljuju prije nego što krenemo sa osnaživanjem i izgradnjom resursa

• Personal and social capital are dynamically linked and supported by community networks

• Lični i društveni kapital su dinamički povezani i podržani od mreža u zajednici

SECTION 4: THE 3-STAGE MODEL: ASSERTIVE LINKAGE AND COMMUNITY CONNECTIONS4.MODEL OD 3 STADIJA: ASERTIVNO POVEZIVANJE I KONEKTORI U ZAJEDNICI

Three-stage approach to REC-CAPPristup REC-CAP-u u 3 stadija

1. Scientific and systematic assessment of strengths and needs Naučna i sistematska procjena potreba i prednosti

2. Recovery care planning to create goals realised through strengths Planiranje nege u oporavku za kreiranje ciljeva realizovanih kroz prednosti

3. Assertive linkage to recovery-supportive groups and activities Asertivno povezivanje sa grupama podrške i drugim aktivnostima oporavka

MPE: Measure, Plan, EngageProcijeniti, planirati, djelovati

“ 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)

Manning et al (2012)• Acute Assessment Unit at the Maudsley Hospital in London• Jedinica akutne procene u bolnici Maudsley u Londonu• Low rates of meeting attendance while on ward• Niska stopa prisustvovanja na sastancima za vrijeme boravka na odeljenju• Randomized controlled trial (RCT) with three conditions:• Randomizovano kontrolisano ispitivanje za tri stanja :

– Information only Samo informisanje– Doctor referral Uputnica ljekara– Peer support Peer podrška

• Those in the assertive linkage condition:• Za osobe u stanju asertivnog povezivanja:

– More meeting attendance (AA, NA, CA) on ward Više prisustvovanja sastancima za vrijeme boravka na odjeljenju

– More meeting attendance in the 3 months after departure Više prisustvovanja sastancima u periodu od 3 mjeseca nakon odlaska

– Reduced substance use in the three months after departure Smanjena upotreba PAS u periodu od 3 mjeseca nakon odlaska

SECTION 5: A MODEL FOR CHANGE: THE RESTORE-RECOVER-REINTEGRATE GEAR SYSTEM 5.Model za promjenu:Obnovi-Oporavi-Reintegriraj

Extending recovery: the 3 phases of criminal desistance (McNeill, 2015)

Proširenje oporavka: 3 faze prekida činjenja krivičnih djela

• Primary desistance (stop offending)

• Primarna (prestati sa krivičnim djelima)

• Secondary desistance (developing a 'redemption narrative' that is accepted by family and friends)

• Sekundarna (razvijanje ‘narativa iskupljenja’ prihvatljivog za porodicu i prijatelje)

• Tertiary desistance (communities accepting that you have changed and allowing your reintegration)

• Tercialna (zajednice prihvataju promjenu individue i omogućavanju reintegraciju)

• Reintegrative or disintegrative shaming

• Reintegrativno ili dezintegrativno sramoćenje

• Desistance and recovery as social justice

• Desistencija i oporavak kao socijalna pravda

The Restore-Recover-Reintegrate Gear System

Restorative Practices:

← RJ & ROSC →

Y Axis: Collective Quality of Life

Reintegration

Community ↑

Families/Groups ↑

Individuals

←←←←←←←

X Axis: Reintegrative/ Disintegrative Shaming

←←←←←← Individuals

↓ Families/Groups

↓ Communities

Disintegration

Restore-Recover-Reintegrate Gear System

Working the gears• Reintegration occurs through a reciprocal relationship with the community, which

accepts the individual and by doing so, strengthens itself.

• Reintegracija se odvija kroz recipročni odnos sa zajednicom, koja prihvata pojedinca i time se osnažuje.

• As the X Axis produces positive energy (though reintegrative shaming), the micro, meso and macro levels rise, creating a virtuous cycle of social justice at systems level.

• Kako X osa proizvedi pozitivnu energiju (uprkos reintegrativnom sramoćenju), mikro, meso i makro nivoi rastu i stvaraju ciklus socijalne pravde na nivou sistema.

• This is represented by the Y Axis, which enhances (or diminishes) quality of life on a collective level.

• Ovo je predstavljeno na Y osovina, koja prikazuje poboljšanje (ili smanjenje) kvaliteta života na kolektivnom nivou.

• If the X Axis produces negative (disintegrative) energy, the power draws down and quality of life on the Y Axis also drops.

• Ako X osa proizvodi negativnu (dezintegrativnu) energiju, snaga opada i kvalitet života na Y osi također opada.

Working the gears• As the power rises or drops, the effect is felt at rising (or falling) levels

from the individual (micro) to families and community levels (meso) and to a broader culture of social justice (macro).

• Rast ili pad snage, odražava se na porast (ili pad) nivoa, od individualnog (mikro) do porodice i nivoa zajednice (meso) kao i na širu kulturu socijalne pravde (makro).

• Whilst restorative practices (represented by the gears on the middle band) are crucial for generating restoration, they have limited power when practised in isolation. Instead, they reach full capacity when drawing upon assets (or gears) found within wider communities, a change that must be reflected at policy level.

• Dok su restorativne prakse (koje predstavljaju zupčanici na srednjem djelu) ključne za obnovu, imaju ograničenu moć kada se praktikuju u izolaciji. Umjesto toga, postižu puni kapacitet prilikom prikupljanja sredstava (ili zupčanika) unutar šire zajednice, promjene koje se mora odražavati na nivou politike.

Contact

• Michael Edwards

• michael.edwards@shu.ac.uk

• medwards68@gmail.com

• +44 07795 032740

THANK YOU!