EXIT FROM TREATMENT: Strategies A short talk by Tim Leighton

1. EXIT FROM TREATMENT: Strategies A short talk by Tim Leighton Director of Professional Education & Research, Action on Addiction • Recovery from Addiction Conference: • Bridging the Gap between Policy and Practice • Chester, April 29 2014

2. Exit from treatment 1.Discontinuing prescribed treatment BlocksStrengths Withdrawal period Motivation Cravings ‘Fed up with lifestyle’ Vulnerability (e.g. mood, drug offers) Proud of achievement May still be around drug use (cutting down or stopping) Previous failed attempts 2. Coming out of residential treatment BlocksStrengths Have to face ‘triggers’ Fully detoxed Loss of 24 hour support A lot of ‘recovery training’ Possible loneliness new potential/actual friends Pull of old friends/places Proud of achievement Vulnerability (e.g. Mood, drug offers) Previous failed attempts

3. Desistance (stopping) vs. maintainance (staying stopped) Reported desistance factors ‘Quite a lot’ or ‘a lot’ Fed up with lifestyle 89.5% Psychological health factors 58.5% Family pressure, criminal justice, physical health problems cited by 40-50% Reported maintenance factors ‘Quite a lot’ or ‘a lot’ ‘Not at all’ Moving away from drug-users 83.5% Having reasonable accommodation 72% Support from friends 65% Religious or spiritual beliefs 58.4% 31.3% Info on this slide from Best et al. (2008) Breaking the habit. Similar factors are found in other studies.

4. Big recovery factors Self-efficacy (confidence that I can remain drug/alcohol free) Negative affect self-efficacy: confidence that I can stay drug free even if I am feeling bad. Social self-efficacy: confidence that I can stay drug-free in social situations. 2. Changes in Social Network Breaking away from using friends Increased association with drug-free friends 3. Spirituality maybe not always religious practices, but meaningful activities, renewed values, caring about life, self and others, connectedness etc.

5. What do people in recovery do? • Actively participate • Do not just receive but give • Take care of themselves • Develop routines • Connect regularly • Start things • I realise this is beginning to look like 5 ways to well-being!

6. What do people in recovery do? • I want to argue that recovery from addiction is a ‘social practice’ • Practices arise in relation to social needs • People discover how to ‘do’ recovery and develop the practice together • There are ‘communities of practice’ in which a person can participate • People exiting from treatment can participate and be helped to learn the practice of recovery

7. What do people in recovery feel? Recovery addresses a person’s ultimate concerns “I didn’t know what I liked – I knew I liked drugs and money but I couldn’t think of anything else” Everyone knows feelings are important in recovery In the rather little known DTORS qualitative study participants often mentioned shame and other painful feelings as crucial to relapsing. Margaret Archer describes ‘human emotions’ as ‘commentaries on a person’s ultimate concerns’

8. What do people in recovery feel? • Ultimate concerns (and the human emotions that arise form these) in three domains: • Physical embodiment – being in the physical world • Practical performance – how well or badly we do things • Social – how acceptable are we to others?

9. What do people in recovery feel? “I get help from my drugs worker who suggests I go to the Job Centre. We work on skills like filling in forms but when I get to the centre I get emotionally overwhelmed and after a while I just walk out.” Shame, feelings of failure, feeling less than others

10. What helps with this? Our identity: Who are we in relation to society? Our values, what we do, what we are concerned with Identity project How we develop our lives in relation to an identity or role which is available to us in the society we live in. It would be possible to develop an identity project as an artist, an academic, a parent etc., maybe a combination of these. They provide values and ways of living. Identities are profoundly related to our emotional lfe

11. What helps with this? • It is possible to develop an identity project as a recovering person. • The recovering communities of practice provide • Knowledge • Training • Tips and tricks • Values (honesty, caring, helping others) • Emotional support (valuing, acceptance, trust, belief in you) • Practical help • Living and coping skills emerge from practice • If you simply provide ‘coping skills’ people may flounder emotionally.

12. What helps with this? Major vulnerability in exiting treatment In my view: disconnection leading to overwhelming negative emotions. The old identity as a drug user is available to manage this. People exiting treatment would benefit from understanding that recovery is an identity project. Negative feelings can be tolerated if you care enough. Caring about things comes from being part of a social group which supports your evolving identity.

13. What helps with this? There are lots of versions of recovery See for example: Livingston, W., Baker, M., Jobber, S., & Atkins, B. (2011). A Tale of the Spontaneous Emergence of a Recovery Group and the Characteristics That Are Making It Thrive: Exploring the Politics and Knowledge of Recovery. Journal of Groups in Addiction & Recovery, 6(1-2), 176-196. Some are more publically visible, others are more private. The basic mechanisms probably don’t vary that much. Having a strong identity as a recovering person does not prevent individuality and creativity.