Transcript Slide 1

Desistance, Recovery & Austerity
Mark Gilman
“Desistance” from crime is:
• a process through which people cease and refrain from
offending.
• a process which is very similar to the journeys that
‘addicts’ and ‘alcoholics’ make from active addiction to
recovery.
• a change in identity and social networks.
• about a job, a house and new friends.
• a process that involves ending dependencies on
professionally delivered services and becoming part of a
positive social network.
Recovering from “addiction”:
• a process through which people cease and refrain from
addictive behaviours.
• a process which is very similar to the journeys that
persistent offenders make from being anti-social
criminals to pro-social citizens
• a change in identity and social networks.
• about a job, a house and new friends.
• a process that involves ending dependencies on
professionally delivered services and becoming part of a
positive social network.
Desisters and People in Recovery:
“do not blame themselves for their problems but
hold themselves responsible for the solution to
their own problems.” Shadd Maruna ‘Making Good’ 2008
“You are not responsible for being down, but
you are responsible for getting up”
Austerity & Public Service Reform in Greater Manchester (GM)
• GM spends around £5bn more
than our total tax contribution
22bn
• Total tax take estimated at £17bn.
Significant investment in growth.
GM economy more resilient than
most
17bn
• Need to sustainably reduce £22bn
public spending
• Proportions have changed – more
on welfare benefits: costs of failure
•New delivery models that move
people towards self-reliance
3.1
20
2.9
15
4.4
5
10
6.5
6.1
7.1
8
2008/09
2011/12
£bn
• Total spend has actually increased
since 2009, despite the cuts
25
5
0
Benefits & tax credits
Local authorities
Health
Other
Social relationships have big impact:
comparative odds of decreased mortality
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Social relationships: Overall findings from this meta-analysis
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
Social relationships have as great an
impact on health outcomes as smoking
cessation, and more than physical activity
and issues to address obesity
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
The process of moving towards self reliance
(FOR THOSE WHO CAN MAKE IT!)
•Positive Social
Network
Treatment
•Mutual Aid
•Recovery
Community
BIO
PSYCHO
SOCIAL
New Models
Medical Treatment & Mutual Aid
CHANGE THIS...
Medical, Clinical Treatment
TO THIS... = +45
% extra capacity
Medical, Clinical Treatment
Mutual Aid
Mutual Aid
Alcoholics Anonymous
produces same outcomes
for 45% lower cost
Over 3 years perperson treatment
costs for AA group:
45 % lower
than ‘professional’
treated groups
with similar
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
Mutual Aid 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, 709-713. Inflated to 2012 prices and converted to approximate pounds sterling.
WHAT WORKS IN RECOVERY?
Setting the standard for recovery:
Physicians' Health Programs
DuPont RL, McLellanAT, White WL, Merlo LJ, Gold MS.
J SubstAbuse Treat.2009 Mar;36(2):159-71. doi: 10.1016/j.jsat.2008.01.004
• Abstinence-based
• use of treatment programs selected for their excellence.
• abstain from any use of alcohol or other drugs of abuse assessed by
frequent random tests typically lasting for 5 years
• close linkages to the 12-step programs of Alcoholics Anonymous
and Narcotics Anonymous (and SMART?)
• 78% of participants had no positive test for either alcohol or
drugs over the 5-year period of intensive monitoring.
• Q. what % should we expect of our “clients” and “patients”
Q. Who do you spend your time with in a typical week?
Identifying and changing social networks
Positive
ProRecovery
people IN
Negative
AntiRecovery
people OUT
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)
Bridging Social Capital
“We are people who normally would not mix” AA Big Book
Bruce Alexander:
The Globalisation of Addiction –
“Poverty of the Spirit”
Spiritual Solutions NOT Religiosity
“Alcoholics” alone & thinking:
“I will only drink
good red wine!”
“I’ll just drink
real ale”!