recovery and recovery cities the social contagion of hope ... · valid bosnia & herzegovina 72...
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Recovery and recovery citiesThe social contagion of hope and inclusion
Professor David Best
Sheffield Hallam University
Australian National University
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Recovery is a personal journey within a social context
The manifestation of recovery is community-based
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Definitions • Betty Ford; UKDPC (et al):
Sobriety, participation, global health
• Leamy et al (2011): CHIME• Connectedness
• Hope
• Identity
• Meaning
• Empowerment
• 58% of people with a lifetime substance use disorder achieve stable recovery
• 50-70% of people relapse in Year 1 after detox; 14% after Year 5
• 79% of people in stable recovery contribute to their community compared to 40% of people never addicted
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RNS Objectives & Orientation
Measure
Plan
Engage | Connect HopeM⁴
Meaning, Mentor,
Monitor, Measure
Empowerment
Identit
y
The Engine of Change
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Three key areas of clear evidence-based models for recovery:
• RECOVERY HOUSING
• MUTUAL AID
• PEER DELIVERED INTERVENTIONS • Peer models are successful because they provide the personal
direction, encouragement and role modelling necessary to initiate engagement and then to support ongoing participation
Recovery enablers -Humphreys and Lembke (2013)
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Time in residence + meaningful activities to positive outcomes (FARR)
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“I support recovery, as long as it’s not in my back yard”
• Public perceptions of addicts (Philips & Shaw, 2013)• 4 populations: smokers, obese people, active and recovering addicts
• The US population generally does not believe in recovery
• Addiction as an irreversible stain
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Changes in work and study over the course of recovery
0
10
20
30
40
50
60
70
80
90
Restoredprofessional
license
Dropped outof school or
college
Got fired orsuspended
Frequentlymissed work
or school
Furtherededucation or
training
Got good jobevaluations
Lostoccupational
license
Steadilyemployed
Started ownbusiness
Early recovery
Sustained recovery
Stable recovery
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Gender differences in recovery
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Life In Recovery in the Balkans
Split by countries Details of participants• 190 (72.2%) male. 27.8% female
• High levels of polydrug use
• Mean onset age of illicit drug use was 15.5 years and the age of most recent drug use was 30.5 years
• 23.6% saw themselves as being 'in recovery'; 37.6% as 'recovered'; 17.9% as used to have a drug problem but don’t now, 10.6% in medication assisted recovery and 10.3% as another status
Frequency Percent Valid PercentValid Bosnia &
Herzegovina 72 27.4 27.4
Serbia123 46.8 46.8
Croatia53 20.2 20.2
Montenegro15 5.7 5.7
Total263 100.0 100.0
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Sources of lifetime help-seeking
12-step 8.0%
PBRSS 9.1%
Resi Rehab, TC or detox 63.9%
Specialist out-patient treatment 53.2%
Other service (such as a church) 44.9%
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Key comparisons with rest of European sample
Balkans (n=263) Other European countries
(n=217)
t, significance
Age of first drug use 15.5 15.9 10.9, ns
Age of last drug use 30.5 32.9 2.49, p<0.05
Age of first help seeking 24.1 25.9 2.45, p<0.05
Time since last problem drug
use (years)
7.2 5.8 2.23, p<0.05
Length of time in recovery
(years)
6.7 4.9 2.86, p<0.05
Age 37.1 38.1 1.13, ns
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How could we, as a society, facilitate & promote recovery?
• Focus on beating stigma, discrimination and exclusion which represent significant barriers to recovery• Invest in meaningful jobs, stable housing, social
relationships• ‘Giving something back’
• Social connectedness and belonging are key
• A change of mindset in the society can promote sustained recovery• Contribute to the growth of community
recovery capital
• Recovery community Co-recovery
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• 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)
• 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
Therapeutic landscapes
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• 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
• Challenge stigma
• Change community recovery capital
Therapeutic landscapes (2)
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Social Recovery
Capital
Collective Recovery Capital
Personal Recovery
Capital
Best and Laudet (2010)
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• There is a strong and dynamic relationship between the three component parts of RC.
• The techniques in the model are intended to support the growth of RC by maximising the resources available to each individual, and based on the assumption that recovery is an intrinsically social process and one that needs not only personal commitment and determination but also the support and engagement of the social network and support system.
(Best, Irving, Collinson, Andersson & Edwards, 2016)
Ice Cream Cone Model
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Funding by:
Innovating for
Improvement
Round 3 Project
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What to link toAsset Based Community Development domains
MUTUAL AID GROUPS (MA)
RECREATION AND SPORT (R&S)
VOLUNTEERING, EDUCATION AND
EMPLOYMENT (VEE)
PEER AND RECOVERY COMMUNITY GROUPS
(PRCG)
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Assets: recreation and sport
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Assets: mutual aid groups
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Assets: peer and recovery community groups
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Assets: volunteering, education and employment
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“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)
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• Acute Assessment Unit at the Maudsley Hospital
• Low rates of meeting attendance while on ward
• RCT with three conditions:• Information only• Doctor referral • Peer support
Those in the assertive linkage condition:• More meeting attendance (AA, NA, CA) on ward • More meeting attendance in the 3 months after departure • Reduced substance use in the three months after departure
Manning et al (2012)
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• The Family Connectors programme utilises the existing social capital of friends/family of the prisoners on the outside.
• These relationships then provide the basis for the restoration of bonding capital (resources within existing networks of the target individual) and the formation of bridging capital (resources outside the immediate network) and so decrease the gap between the prisoner and the community.
The KFC Programme
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Strategy to enhance recovery: building an inclusive city
Different stakeholders working together
• City council
• Public & private organisations
• Criminal justice actors & treatment providers
• Family & friends
• Citizens
• People in recovery
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Inclusive cities paper
Best & Colman (in review)
Central idea: no one should walk the recovery path alone. An inclusive citypromotes participation, inclusion, full and equal citizenship to all her citizens, also to those in recovery
Central aim: 1) challenge social exclusion at city level 2) make recovery visible, celebrate it and create a safe environment
supportive to recovery• “Recovery is contagious”
Beneficial for the person in recovery, as well as for the community as a whole• “The helper principle”
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Radio Gaga
Recovery bike rideSerenity cafe
Jobs, Friends & Houses
San Patrignano
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How to build inclusive cities?
For example in Ghent:
1. Bring several actors from different organisations responsible for housing, employment, social welfare,… together. Include people in recovery as well!
2. Make an overview of existing practices for people in recovery
3. Identify gaps
4. Define the city’s mission, vision statement, goals (short- term and long-term) and actions towards people in recovery
5. Monitor, evaluate and adapt!
Several promising examples
• Small actions or big actions (according tomindset & resources available)
The most important step however, is to bring it all together and to create partnerships
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Where to next?
Not just for heroin and alcohol. This is a way of tackling the new spice issues in town centres and the links to hopelessness and homelessness
Website (under construction):
https://charlottecolman1.wixsite.com/inclusivecities