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Public Health England Healthcare Professionals and AA. Mark Gilman Strategic Recovery Lead National Treatment Agency. Slide 1. 45% lower cost for same outcomes. Over 3 years per-person treatment costs for AA group: 45 % lower than ‘professional’ treated groups with similar outcomes.

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  1. Public Health England Healthcare Professionals and AA Mark Gilman Strategic Recovery Lead National Treatment Agency Slide 1

  2. 45% lower cost for same outcomes Over 3 years per-person treatment costs for AA group: 45 % lower than ‘professional’ treated groups with similar outcomes. Mutual Aid (AA) reduces on-going treatment costs Keith Humphreys, PhD Professor (Research) of Psychiatry and Behavioural Sciences Stanford Health Policy Associate Senior Policy Advisor at the White House ‘Circles of Recovery’ Cambridge University Press, 2003 Humphreys, K., & Moos, R. (1996). Reduced substance abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatric Services, 47, 709-713. Inflated to 2012 prices and converted to approximate pounds sterling.

  3. Integrating Drugs & Alcohol. Treatment & Recovery. CHANGE THIS... Treatment Community Recovery Communities TO THIS... = +45 % extra capacity Treatment Community Recovery Communities

  4. Who Recovers? Everyone CAN recover Not everyone WILL recover We don’t know WHO will recover So, give everyone EVERY CHANCE

  5. Social relationships have big impacts – not just on mental health and wellbeing but also ‘hard’ impacts like mortality Meta analysis: comparative odds of decreased mortality social relationships have as great an impact as smoking cessation, and more than physical activity and issues to address obesity LGID: Wellbeing - why bother? Source: Holt-Lundstad et al 2010 5

  6. Bridging Social Capital “We are people who normally would not mix” AA Big Book

  7. What does “Every Chance” look like? Social Networks Social Relationships AA Psychotherapeutic Bio Medical

  8. “There is a Solution we know How it Works” Twelve Step Facilitation UK The therapeutic value of one alcoholic helping another “I cant but WE can” “You alone can do it but you cannot do it alone”

  9. Twelve Step Facilitation (TSF) • Grounded in principles of Alcoholics Anonymous (AA) Goals of TSF are to: • motivate and support abstinence based recovery • acknowledge the need for active participation in 12-step programming as a means of achieving abstinence based recovery • exposure to 12 step fellowships during (not after) treatment.

  10. Measures of 12-step affiliation • Meeting Attendance: Number of AA meetings • Having a home group • Having a sponsor • Doing service • Working the steps • Sponsoring someone • Reading recovery literature • Considering oneself a 12-step member • Contacting 12-step members outside of meetings • Socializing with other members outside of meetings.

  11. How separate or different are 'psychosocial interventions' and 12 Step Fellowships? Circles of Recovery, Keith Humphreys

  12. Bruce Alexander: The Globalisation of Addiction – “Poverty of the Spirit”

  13. Spirituality & Recovery • ‘a common factor in successful recovery is spirituality’ • ‘giving something back’ • ‘become better than well’ • in ‘public organisations’ and ‘official circles’ ‘spirituality’ misheard as ‘religion’ • Spirituality is observable human phenomenon - a ‘healing shift’

  14. A Public Health View of Recovery’sHealing Shift • A plausibility structure • A story or set of ideas that underpin recovery • E.g. “My name is Bill I’m an alcoholic” • A community of support • AA Recovery meetings • A daily practice to support the change • Just for today I will…

  15. 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)

  16. So, why isn't AA promoted in NHS? CPTI • “Our clients don’t like it, they won’t go…” • “12 step is not for everyone…” • “They’re just swapping one addiction for another…” • “If they go there they wont need me…”

  17. “Crabs in a Barrel”

  18. Identifying and changing social networks Q. Who do you spend your time with in a typical week? Positive Pro-Recovery people IN Negative Anti-Recovery people OUT

  19. Higher Power Controversy

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