Wrexham Recovery from Addiction Pilot Project (WRAPP)

Wrexham Recovery from Addiction Pilot Project (WRAPP) Prof John Stoner CSARS Group University of Chester

Wrexham Recovery from Addiction Pilot Project (WRAPP) WRAPP: • a partnership Twelve Step Facilitation (TSF) pilot project • funded by Welsh Government • delivered on behalf of the North Wales Area Planning Board PARTNERS: • Wrexham County Borough Council, Substance Misuse Advisory Team (WCBC SMAT), • AVOW - Association of Voluntary Organisations in Wrexham • CSARS Group, University of Chester.

SERVICE USERS’ REQUIREMENTS AND SERVICE PROVIDERS’ RESPONSE “Perfect Engagement” Consultation Event 14th February, 2013, Wrexham Hosted by WASUP (Wrexham Alliance Service User Partnership) on behalf of AVOW

Service users’ requirements • Recognition of users’ low Recovery Capital and self- esteem, they feel unsupported • Accommodation – housing, hostels • Education, training and employment • Inadequate and unaffordable transport • Poor communication between individual service providers and users • Current services are seen as bureaucratic and unresponsive to users’ needs • Lack of treatment (rehab, detox), out-of-hours and aftercare services • Strong preference for support workers in recovery themselves – they “understand”

Service providers Priority recommendations • Aftercare support and services to be developed (Resources?) • ‘Out of hours’ support to be developed (Resources?) • Review need for paperwork and engage more with service users (Progress?) • Monthly Service Provider Delivery meetings. • To work towards a consensus of what Service User involvement means to Providers and Service Users

Likely shortfall in service provision • Recovery services (rehab, detox, aftercare) • Support for individual service users • Linking to mutual-aid groups Adapted from the Perfect Engagement Report, 2013 Progress review in June 2014

ADDRESSING THE SHORTFALL: COOPERATION AND TWELVE STEP FACILITATION “More rigorous evidence in support of AA emerging in the past 20 years, in particular, has moved AA from a peripheral status to playing a more central role in a recovery-oriented system of care …. Stemming from these findings on AA’s broad reach, effectiveness, and cost-effectiveness, professional interventions have been developed and tested, designed specifically to engage patients with these community mutual-help resources during and after treatment. These “Twelve-Step Facilitation” (TSF) interventions have been found to enhance patient outcomes in randomized controlled investigations.” (John F. Kelly & William L. White, 2012)

TSF: MAAEZ Manual Making Alcoholics Anonymous (& NA) Easier developed by Lee Ann Kaskutas and Edward Oberste Alcohol Research Group Berkeley, CA 94709

MAAEZ OUTCOMES & OBJECTIVES • Facilitating participation in AA/NA • Preparing clients for transition into AA/NA culture • Addressing some of the myths about AA/NA • Explaining how AA/NA helps and operates • Providing a safe group for individual’s to exchange experiences

WRAPP: project aimsWrexham Recovery from Addiction Pilot Project • Supporting a group of 20people with substance-misuse problems and wanting to achieve abstinence-based recovery. • Introducing the participants to the principles of 12-Step recovery programmes and local mutual-aid groups such as AA and NA. • Providing support for participants in early recovery • Providing training to improve staff awareness & understanding of 12-Step recovery programmes & groups (40 staff)

WRAPP: project teamWrexham Recovery from Addiction Pilot Project • Tony Ormond – Service User Involvement Coordinator, AVOW • Tim Roberts - Project Officer, CSARS Group, University of Chester & AVOW Volunteer. Formerly Rhoserchan & Park View Treatment Centres • Jim B – AVOW Volunteer & AA liaison • John Stoner - Visiting Professor & Co-Director of CSARS Group, University of Chester, Professorial Research Fellow, Centre for Research into Environment and Health, University of Aberystwyth, Formerly Rhoserchan Treatment Centre We gratefully acknowledge the support of key staff and the cooperation of AA & NA

WRAPP DELIVERYWrexham Recovery from Addiction Pilot Project • A four-month project December 2013 – March 2014, compressed due to delays in funding approval. • Recruitment took place in December/January and the programme ran from January – March 2014. • Staff training events held in late January & March • Participants were supported through a weekly programme of WRAPP activities comprising workshops, group sessions and facilitated attendance at local AA and NA meetings. )

WRAPP: STAFF TRAINING EVENTS Wrexham Recovery from Addiction Pilot Project • Twelve-Step Approaches to Recovery and Engagement with Mutual – Aid Groups • Government Policy, Service User Requirements and Resources Available • Twelve Step spirituality (Higher Power Project) • AA/NA Members’ Shares on their experience, strength and hope of recovery • WRAPP Preliminary Outcomes • Delegates were also offered the opportunity of accompanied attendance at local AA/NA meetings. 60 attendees, 36 feedback questionnaires

WRAPP OUTCOMES: staff attitudesWrexham Recovery from Addiction Pilot Project Some Perceptions of AA/NA Before Training • Support for people. Don’t know anything about them. • Religion based (structured) groups. America, Christian based ethos. • Advantages - Holistic approach, the persons responsibility, it’s cheap. Disadvantages -its image may be off putting. • Mixed, (Advantages) I realise that all of the above have helped people turn their lives around who would not have survived, (Disadvantages) but I worry that the dependency on the group simply replaces the dependency on the drug / alcohol • My Straight Head – acceptance, recovery: My Cynical Side – stigma, god, higher power, forced down your throat: • Advantages – fellowship, sense of belonging/ community support. Disadvantages – Abstinence is not for everyone, can become over dependant and Evangelical. How informed have referrals to AA/NA been?

WRAPP OUTCOMES: staff attitudesWrexham Recovery from Addiction Pilot Project Some Perceptions of AA/NA After Training • … spiritual / religion and different understanding. • … only disadvantages are the religious image and the life long fight. BUT loads of pluses, effective increased wellbeing and health, abstinence and wellbeing. • Changed a lot, you have shown me a lot and I have a lot more feelings and opinions about AA and NA.. I understand the 12 steps more now • Hearing personal stories and how people have tackled their problems, as well as beating some myths through the day have helped me (appreciate)the benefits of these groups • Good support network for people, more awareness and better understanding, the stories helped • Support system for life- after detox and rehab centres and treatment units. Has politics as all interventions do, but works well with open door policy • Radical changes are needed to change the concept of AA and NA, I understand better what is needed to improve the profile • I just wish that judges where able to order people to go and that there was less stigma attached to admitting you are an addict or alcoholic.

WRAPP OUTCOMES: staff attitudesWrexham Recovery from Addiction Pilot Project Attendance at AA/NA Meetings Before Training: • 83% (30) had never attended a meeting After Training: • 78% (28) said that they intended to attend a meeting • 14% (5) have subsequently attended meetings accompanied by AA/NA members Follow-up required to encourage/facilitate attendance

WRAPP OUTCOMES: staff attitudesWrexham Recovery from Addiction Pilot Project Client Referrals to Mutual-Aid Groups AA/NA Before training: • 22% (8) Never • 11% (4) Rarely • 17% (6) NA • 25% (9) Sometimes, when appropriate • 25% (9) Regularly/routinely After training: • 94% (34) intend referring clients, many with enthusiasm Follow-up required if this intention is to be translated into positive referrals

WRAPP OUTCOMES: staff attitudesWrexham Recovery from Addiction Pilot Project Following accompanied attendance at an AA/NA Meeting: • I did enjoy the meeting last night, it gave me a huge insight into people's experiences and the difficulties alcoholics have to overcome everyday which we would take for granted. I will try and persuade people who I come across that there is hope and spread the word of AA and the other fellowships out there. I was impressed by the support you all give each other and "got it" If you know what I mean! Susan Carrington ASB Officer North Wales Police • I found it hugely uplifting and the experience was one of warmth, acceptance and support that is unrivalled by anything that I have been involved with before. I truly feel honoured to have seen a fellowship in action, so thank you. Vicky Jones, Performance Improvement and Partnerships Manager, Wrexham CBC

WRAPP OUTCOMES: staff attitudesWrexham Recovery from Addiction Pilot Project Following accompanied attendance at an AA/NA Meeting: • I could not believe how welcomed and relaxed I felt. The people were so open, honest and accepting of everybody. From a commissioning perspective it made me realise that we need to think carefully about how and by who services are best delivered. It also made me think about how we get more people to engage with groups like this, we would welcome any advice you can give. Shirley Jones, Supporting People Manager • Thank you for supporting me to attend last night’s meeting, I found it very insightful. Dawn Lewis, Community Diversity Officer, Wrexham CBC

WRAPP OUTCOMES: recruitmentWrexham Recovery from Addiction Pilot Project • Experience to date suggests that there have been significant awareness and resistance issues towards 12-Step recovery amongst local staff involved with substance misuse issues. • Low referral rates to WRAPP from other agencies – 11 people referred, only 5 attended for assessment. • The remaining participants found WRAPP through word of mouth, publicity, a service-user event and personal contact with service users by WRAPP staff.

WRAPP OUTCOMES: ASSESSMENTWrexham Recovery from Addiction Pilot Project • Assessment criteria used at interview: - Duration of active addiction - Engagement history with drug & alcohol services - Willingness to change, attitude & behaviour - Perceptions/previous engagement with AA/NA - Physical / Social / Psychological mitigators - Emotional responses to structured recovery options - TOPPS and ARC assessment tools were used to augment weekly assessments of individual progress and change • Candidates assessed: 19 • Participants selected: 16 displayed some willingness to change, but several had significant health, other or motivational issues making completion of the course problematic.

WRAPP weeklyPROGRAMMEWrexham Recovery from Addiction Pilot Project WORKSHOP SESSIONS • Registration and Introduction • Accepting Help and Twelve-Step Spirituality • Changing: Characteristics of Addiction and Recovery • Changing and Living in the Day • Living Clean and Sober • Managing Emotions and Living with Others • Relapse Process and Prevention • Developing Individual Recovery Plans • Review Session: Living Sober and Relapse Prevention Workshops supported by group and individual sessions

WRAPP SupportWrexham Recovery from Addiction Pilot Project • Participants were supported to develop their own individual recoveries by trying to remain abstinent, undertaking homework, and integrating with local recovery groups and communities. • They were encouraged to independently attend additional AA/NA meetings and get involved with other local recovery activities. • AVOW provided support for participants generally and referred individuals to other services when appropriate.

WRAPP OUTCOMES: RETENTION 1Wrexham Recovery from Addiction Pilot Project 16 initial participants assessed weekly: • 7 (44%) completed the programme and are making good progress. They have attended most of the WRAPP sessions, attend between 1 and 4 AA/NA meetings weekly and have engaged with local AA/NA members & groups, several have a sponsor. • 9 (56%) attended between 1 and 3 WRAPP sessions and dropped out of the programme for a variety of reasons Follow-up studies planned after 1 & 2 years

WRAPP OUTCOMES: RETENTION 2Wrexham Recovery from Addiction Pilot Project Of the 9 participants who dropped out of the WRAPP Programme: • 3 have since been in touch with us to let us know that they are pursuing their own path of action within their fellowships • 2 were able to get into detox during the running of the course • 2 left because they felt they didn’t need it anymore • 2left and have not been contactable since Positive outcomes for 75% of participants

WRAPP OUTCOMES: Feedback 1Wrexham Recovery from Addiction Pilot Project Feedback from participants on the WRAPP Group: • WRAPP is a great support group that also gives you a foot into AA and after-support, which I feel I lacked the last time I attempted to stay sober. • I love the talking, sharing and debating in the group, it helps you to understand your own feelings. • IT’S NOT JUST YOU! • WRAPP is good and I have seen a difference in myself. Going to AA as part of WRAPP is good. • I have been sober for a while now and being in group has done me good – I think it would help other people too.

WRAPP OUTCOMES: Feedback 2Wrexham Recovery from Addiction Pilot Project Feedback from participants on their recoveries: • It gave me a massive head-start. I got things quickly in the rooms once I found them. I probably wouldn’t have found the rooms by myself anyway • I realise that I can have a happy, honest and good life without alcohol. • Two choices exist (for me): - A life of carnage, no family, no business, no friends, no future - A fulfilling life with people I love and the possibility of a good future • AA and other support will help me keep sober

WRAPP OUTCOMES: Lessons learntWrexham Recovery from Addiction Pilot Project • The low WRAPP referral rates from most Wrexham agencies was disappointing but understandable. • Feedback suggests that staff training was effective in improving staff understanding of and future commitment to 12-Step recovery through mutual-aid engagement. • Despite recruitment problems, WRAPP has confirmed TSF as a cost-effective intervention: 7 of 16 (44%)participants still engaged with the programme, a further 5 (31%) pursuing recovery through different routes • There is considerable support amongst graduate participants, partner organisations and local staff to build upon the success of the pilot project and develop a sustainable mutual-aid engagement project in Wrexham.

WRAPP OUTCOMES: what next? Wrap?Wrexham Recovery from Addiction Pilot Project • There is a requirement from government and service users for provision of a recovery option through mutual-aid engagement and recovery communities. • Despite time constraints and recruitment issues, the pilot project has confirmed that TSF is a cost-effective option for those wishing to achieve abstinence-based recovery. WRAP Proposal Benefits • builds on what has been achieved by the pilot project – individuals and organisations • establish sustainable and cost-effective abstinence-based recovery options • provide a safe recovery group for those in early recovery involving trained volunteers • contribute towards improved “joining-up” of service provision

Wrexham Recovery from Addiction Pilot Project (WRAPP)