Transcript Slide 1

Launch of Recovery Academy Australia RAA
Aspiring to and supporting the principles of recovery
Launch Program
2.00pm
2.05pm
2.10pm
2.45pm
2.50pm
3.10pm
3.30pm
4.00pm
Welcome and Introductions
Message from William White
Personal Reflections on Recovery
What is Recovery? – Audience Survey
Break
Dr Jack Warhaft
“Medical & Personal Aspects of Recovery”
Assoc Prof David Best
“The Benefits of a Visible Recovery Movement”
Reflections & Closing Message
Message from William White
video
Personal Reflections of Recovery
Jess, Glenda and James
Launch Program
2.00pm
2.05pm
2.10pm
2.45pm
2.50pm
3.10pm
3.30pm
4.00pm
Welcome and Introductions
Message from William White
Personal Reflections on Recovery
What is Recovery? – Audience Survey
Break
Dr Jack Warhaft
“Medical & Personal Aspects of Recovery”
Assoc Prof David Best
“The Benefits of a Visible Recovery Movement”
Reflections & Closing Message
Medical & Personal Aspects of Recovery
Dr Naham (Jack) Warhaft
MBBS, FANZCA, GradDipSubsAbuse, FAChAM (RACP)
Medical Director, Addiction Recovery Program,
Malvern Private Hospital
Areas to be addressed
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A personal journey
Recovery options
Recovery pathways
Role of Addiction Medicine Physician
Aftercare
Working with others
A personal journey
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Alcohol dependency
Polydrug dependency
Multiple relapses - 6 detox/rehab admissions
Stable recovery for 20 years
– Specialist anaesthetist
– Founding Medical Director, VDHP, 2001-2007
– Consultant addiction medicine physician since
2004
BRIDGE WALK TO RECOVERY,
MELBOURNE 15.4.2012
Recovery Options
• Recovery implies a desire to change.
• Recovery is not for everyone!
– Contented with drug use
– Discontented but not wanting to change
– Hopelessness
Recovery Pathways
• Non-assisted (‘spontaneous’)
recovery
• ‘Maturing out’ (developmental)
• Medical conciousness
• Religious conciousness
• Political conciousness
• Medication supported recovery
• Abstinence based recovery
Recovery Pathways
– Professor Thomas McLellan was President Obama’s number two drug
policy guru
– He says the recovery movement is definitely not a
front for AA, but that, in America, more people
have gotten sober and into recovery from AA than
in just about any other way, and that recovery is a
state of being, not a method.
– “Fine, don’t use AA. Get a priest, get a buddy, take
a medication, go to a drug court, find a good
woman – whatever. There are 50 ways to get into
recovery.”
– (quoted from Patrick Griffiths, ANEX)
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Role of Addiction Medicine Physician in initiating
and maintaining Recovery
• The provision of medical support to an
individual on a recovery pathway
• Acknowledgement of the importance of
psychoeducational and psychosocial
management and peer support in the
recovery process, and provision of the medical
support to facilitate that change
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Key medical components
• Diagnosis of substance use disorder along with
general health assessment
• Medical detoxification when indicated
• Medication for physical health problems
• Assessment and treatment of mental health
problems, including psychiatric referrals when
indicated
• RECOVERY SUPPORT - including ‘assertive
linkage’.
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Assertive linkage
• The physician uses his/her knowledge and
authority to connect the client to a recovery
program
• The physician should be very familiar with
recovery programs
– and have contacts in these programs
– and work closely with recovery counsellors
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Working with othersA TEAM APPROACH
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Medical - doctors, nurses
Psychological - counsellors, psychologists
Textlawyers
Social - social workers,
PEER SUPPORT PEOPLE - mentors, sponsors
FAMILY SUPPORT
COMMUNITY SUPPORT
ASSUMPTION
• THE MOST IMPORTANT PART OF
RECOVERY HAPPENS OUTSIDE SPECIALIST
SETTINGS, AND GENERALLY WITH THE
SUPPORT OF PEERS
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Conclusion
• Recovery means different things to different
people
• There are many roads to Recovery
• Doctors have a key role, as members of the
‘recovery team’
• It is a privilege to be working in this challenging
and rewarding medical speciality
• I am indebted to the many people who have
supported my own recovery
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The Benefits of a Visible Recovery Movement
Associate Professor David Best
Areas to be addressed
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Connectedness
Social capital
Activity
Visibility
Social networks and quality of life
• Holt-Lunstad et al (2010): meta-analysis: “individuals
with adequate social relationships have a 50%
greater likelihood of survival compared to those with
poor or insufficient social relationships” (p.14)
• Participation in groups is associated with less
psychological distress (Ellaway and MacIntyre, 2007)
• Volunteering is associated with reduced mortality
(Ayalon, 2008) and higher levels of reported
wellbeing (Morrow-Howell et al, 2003)
Litt et al – “Changing network support
for drinking” (2009)
• 186 participants randomised to network support (NS) or case
management (CM)
• Network support condition resulted in better outcomes than
case management
• “The addition of just one abstinent person to a social
network increased the probability of abstinence for the next
year by 27%” (p230)
• Social networks can be changed by an intervention that is
specifically designed to do so
• McKnight and Block (2010): Stronger support networks linked
to better access to community resources and to better health
Framingham Heart Study
Christakis and Fowler
• A person’s odds of becoming obese increased by 57% if
they had a friend who became obese, with a lower risk
rate for friends of friends, lower again at three degrees of
separation
• No discernible effect at further levels of remove
• Smoking cessation by a spouse decreased a person’s
chances of smoking by 67%, while smoking cessation by a
friend decreased the chances by 36%. The average risk of
smoking at one degree of separation (i.e., smoking by a
friend) was 61% higher, 29% higher at two degrees of
separation and 11% higher at three degrees of
separation.
Line = a relationship between two people
more embedded = central
less embedded = periphery
Node = a person
“embedded”: the degree to which a person is connected within a network
Terms
• Contagion:
what flows across ties
(germs, money, violence, fashions,
organs, happiness, obesity, etc.)
• Connection:
who is connected to whom
(ties to family, friends, co-workers, etc.)
• Homophily:
the tendency to associate
with people who resemble
ourselves
(“love of being alike”)
The Obesity “Epidemic”
Your Friends’ Friends Can Make You Fat
Photos by Colin Rose and Sherrie
G
The Obesity “Epidemic”
• 66% of Americans are overweight or obese
• From 1990 to 2000, the percentage of obese people in the USA increased from 21% to
33%
Green Node: nonobese
Yellow Node= obese (size of circle is proportional to BMI)
1975
1990
TRADITIONAL SCOTTISH LUNCH
BRIDGE WALK TO RECOVERY,
MELBOURNE 15.4.2012
Forms of social capital
Szreter and Woolcock (2004)
1. Bonding: trusting and cooperative relationships
between members of a network who share an
aspect of social identity
2. Bridging: relations of respect and mutuality
between people who know they are not alike in
some respect
3. Linking: norms of respect and development of
trusting relationships between people
interacting across explicit formal or
institutionalised power barriers
Ziersch’s (2005) model of social capital
SOCIAL CAPITAL
INFRASTRUCTURE
SOCIAL CAPITAL
RESOURCES
Cognitive: Trust,
reciprocity
Social support
Social cohesion
Civic activities
Structural: Formal
networks, informal
networks
Best and Laudet (2010)
Personal
Recovery
Capital
Social
Recovery
Capital
Collective
Recovery Capital
Social and mental health benefits of
choir singing for disadvantaged
adults
• Reclink community choir engagement at
baseline, 6 and 12 months -21 IPA interviews
• PERSONAL IMPACT: positive emotions,
emotion regulation, spiritual impact, identity
• SOCIAL IMPACT: connectedness with choir,
with audience, with community
• FUNCTIONAL IMPACT: health, employment
capacity, routine and structure
Dingle, Brander, Ballantyne & Baker (2012)
Dingle et al (2012): Personal, social
and functional growth
Recovery studies in Birmingham and Glasgow
(Best et al, 2011a; Best et al, 2011b)
– More time spent with other people in recovery
– More time in the last week spent:
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Childcare
Engaging in community groups
Volunteering
Education or training
Employment
BASELINE SAMPLE IN YORK
• Method was to recruit visible recovery
champions and identify recovery strengths in
this population
• Supplement with a treatment population
• Assess wellbeing and recovery functioning in
this group
• Professional attitudes and experiences
• Key informant perceptions
Characteristics of the three groups
Visible recovery
group (n=20)
Community
recovery (n=17)
Treatment group F, significance
(n=50)
39.8
38.5
35.3
2.72
Health problems 12.0
5.7
17.9
18.72***
Recovery group
participation
8.8
4.5
0.4
62.65***
ARC personal
20.5
22.8
14.1
20.97***
ARC social
19.3
21.9
11.2
29.75***
Active users in
network
People in
recovery in
network
People never
used in network
3.2
2.3
12.8
8.41***
14.1
6.8
3.4
5.12**
5.0
5.7
3.5
0.50
Age
Differences in wellbeing and
connectedness
Visible
Community
recovery
recovery
group (n=20) (n=17)
Treatment
Chi,
group (n=50) significance
Positive rating of quality of life
50.0%
76.5%
22.0%
29.27***
Satisfaction with health
55.0%
76.5%
18.0%
26.43***
There is a special person around
when i am in need
75.0%
52.1%
30.0%
20.40***
My friends really try to help me
55.0%
56.3%
16.0%
30.39**
I can count on my friends when
things go wrong
50.0%
56.3%
16.0%
35.85***
I can talk about my problems with
my friends
45.0%
64.7%
16.0%
38.36***
Recovery resources in York and North
Wales
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16
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NHS
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CAIS
10
ARCH
Hafan Wen
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Tyn Rodyn
Touchstone 12
6
York Recovery
4
York Treatment
2
0
P e r so n a l R e c o v e r y
S oc i a l R e c ov e r y
R e c o v e r y Gr o u p
C a pi t a l
C a pi t a l
P a r t i c i pa t i on
VISIBILITY OR NOT – STUDY OF HIV
POSITIVE GAY MEN
• Cole et al (1996): study of the long-term effects of
hiding their sexual identity: associated with higher
rates of cancer and infectious disease
• Jones et al (2012): Those who hide a potentially
stigmatising condition more vulnerable to the negative
views that mainstream society holds because it limits
their ability to develop a collective coping response
• Molero et al (2011): while there were risks, disclosing
their HIV status allowed individuals to develop a sense
of shared identification with others in the same
situation
VISIBILITY OR NOT - ABI
• Molero et al (2011): Concealment of injury
may be an important strategy for protecting
oneself from negative outcomes
• However, respondents who were more willing
to disclose their injury to others reported
higher levels of self-esteem and life
satisfaction
Conclusion
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Connectedness
Hope
Identity
Meaning
Empowerment
• Bridging capital
• Bonding capital
• Recovery champions
• Community focus
• Social Identity Model of
Identity Change