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

45% lower cost for same outcomes 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 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 Humphreys, K., & Moos, R. (1996). Reduced substance abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatric Services, 47, Inflated to 2012 prices and converted to approximate pounds sterling.

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

Who Recovers? 1. Everyone CAN recover 2. Not everyone WILL recover 3. We don’t know WHO will recover 4. So, give everyone EVERY CHANCE

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

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

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

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

Twelve Step Facilitation (TSF) Grounded in principles of Alcoholics Anonymous (AA) Goals of TSF are to: 1. motivate and support abstinence based recovery 2. acknowledge the need for active participation in 12-step programming as a means of achieving abstinence based recovery 3. exposure to 12 step fellowships during (not after) treatment.

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.

Click to edit the outline text format  Second Outline Level Third Outline Level  Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles – Second level Third level – Fourth level » Fifth level How separate or different are 'psychosocial interventions' and 12 Step Fellowships? monitor for relapse-promoting cognitive distortions adopt behavioral changes that are congruent with more positive mood use stimulus-control methods to eliminate alcohol consumption no stinking thinking fake it until you make it avoid slippery people, places, and things Circles of Recovery, Keith Humphreys

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

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’

A Public Health View of Recovery’s Healing 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…

Social Capital Robert 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)

Click to edit the outline text format  Second Outline Level Third Outline Level  Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles – Second level Third level – Fourth level » Fifth level So, why isn't AA promoted in NHS? “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…” CPTI

“Crabs in a Barrel”

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

Higher Power Controversy