Mark Gilman - Public Health England

Public HealthRecovery and Families

Mark GilmanStrategic Recovery LeadPublic Health England

Health Warnings & Clarifications“Addiction” & “Alcoholism”

• Not just about 12 step fellowships

• It is equally about SMART Recovery Mutual Aid

• It is about getting people into a support network

• Al Anon and Famanon

• Social relationships are a matter of life and death

• Asset Based Community Development (ABCD)

• 5th Wave Public Health

Some Addictive Behaviours in Public Health Context

• Smoking tobacco - COPD (e.g. Emphysema)

• Eating too much bad stuff (sugar addiction?) – “Diabesity” obesity & type 2 diabetes

• Drinking too much alcohol (how much is ‘too much’? UK, USA, Europe?)

• Smoking “skunk” type high potency cannabis

• NPS (Novel Psychoactive Substances, ‘legal highs’)

• “Addiction” to alcohol, benzodiazepines, opioids (heroin) and crack cocaine

• Socially Isolating

What’s the problem in your family?

Abstainers

Binge Drinker/User

SOCIAL Drinkers and Users

Heavy User

“Addicts” “Alcoholics”

What is the level of loved one’s use?

Occasional Use

Recreational Use

Binge Use

• e.g. Drink Driving

• e.g. Fatal Overdose

Continued

Harmful Use

• Physical problems

• Dependency

Overwhelming involvement

• “Addiction”• “Alcoholism”

Features of their involvement: bio-psycho-social

Psychological

Social

Biological

What kind of substance problem? Binge Drinker/User?

Heavy drinker/User?

“Alcoholic”? Alcohol “Addict”?

What do different types need to do?Bingers Get a different hobby

Heavy Users Control your drinkingKeep a drink diary

“Alcoholics”“Addicts”

Stop & Stay Stopped

Abstinence as a basis for Recovery from Addiction?

“…because you have to turn the water off to mend the plumbing”

“Alcoholics” and “Addicts” Controlled Drinking/Recreational Use?

“…down to one beer a day now!”

Right! I’m In Treatment but Socially Isolated?

• But, I’m alone…

• I’m alive

• I’m not in prison

• I’m HIV free

“Alcoholics” & “Addicts” alone & thinking:

“I’ll just buy a bag on pay day!”

“I will only drink good red wine!”

CONNECT?Groups?

Mutual Aid?Nah! I can do it on my own!

“I'm not getting in that lifeboat me!”

“Keep rowing people!”

• Positive Social Network

• Recovery Community

Treatment

Bio-Medical and Psychological Treatments

+ Positive Social Networks

BIO PSYCHO SOCIAL

Social relationships: Overall findings from this meta-analysis

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

Social relationships have big impact:

comparative odds of decreased mortality

Social relationships: High vs. low social support contrasted

Social relationships: Complex measures of social integration

Smoking <15 cigarettes daily

Smoking cessation: Cease vs. continue in patients with CHD

Alcohol consumption: Abstinence vs. excessive drinking

Flu vaccine: Pneumococcal vaccination in adults

Cardiac rehabilitation (exercise) for patients with CHD

Physical activity (controlling for adiposty)

BMI: Lean vs. obese

Drug treatment for hypertension in populations > 59 years

Air pollution: low vs. high

Holt-Lunstad J et al. PLoS Med. 2010;7:e1000316

Social relationships have as great an impact on health outcomes as smoking

cessation, and more than physical activity and issues to address obesity

Positive Social Network

Mutual Aid (MA)

MA Brand X

MA Brand Y

MA Brand Z

PHE Endorses

BUTPHE does not endorse

any MA ‘Brand’

“There is a Solution we know

How it Works”

“I can’t but

WE can”

“You alone can

do it but you cannot do it

alone”

REDISCOVERINGALCOHOLICS ANONYMOUS POSITIVESOCIALNETWORK

Assertive Linkage to Mutual Aid

• SMART Recovery UK

• Twelve Step Facilitation UK

• “You alone can do it but you cannot do it alone

• “I cant but WE can”

• "The therapeutic value of one “addict” helping another”

“None of these guys are staying sober!” “But you are Bill!” (Al Anon is born)

AL ANON MUTUAL AID FOR FAMILIES AND FRIENDS

'When Love is Not Enough' "Our hearts do not need logic, they can love and forgive and accept that which our minds

cannot comprehend. Hearts understand in ways our minds cannot"

Lois Wilson, Founder of Al Anon

Identifying and changing social networksQ. Who do you spend your time with in a typical week?

Positive Pro-

Recovery people IN

NegativeAnti-

Recovery people OUT

Recovery does slowly what drink, drugs & medications do fast...

...changes perception of reality.

Learning how to fit in

To live life on life’s terms

Free from addiction

Free from fear

“Community as method”

Recovery community a place where you learn how to live

right, with other people...

Al Anon & Famanon

‘Goodbye, Mr. Wonderful’ (Chris McCully 2004)

“Any fool can give up for a week or a month. For recovery to last, it has all got to change…are

you prepared to undertake all the changes another persons recovery might mean?”

“I preferred you when you were…”

Dear Chris, page 71…

Benefits of Family Involvement

Participation by family members is associated with better treatment compliance and outcome.

Family members gain a clearer understanding of recovery.

Family members and the person in recovery understand their respective roles and goals.

Family members and the person in recovery get support in the recovery process.

Al Anon & Famanon