Monday, August 26, 2013

Social Recovery and Abstinence

This was truly one of the very best presentations that I have ever heard. It was given as part of the CME  at the IDAA 2013 conference in Denver, Colorado. The presenter was truly inspiring and a great presenter. I apologize for these rough notes and have recommended to friends that I'd encourage anyone who wants some cutting edge research and a terrific presentation to get in touch with Dr. David McCartney……Despite being from Scotland he spoke the English language with great clarity.
I was further impressed to learn of the great work being done by Bill White whose original papers I'll definitely be obtaining.
National Health Service UK LEAP
Lothians and Edinburgh Abstinence Program
Recovery and Social Factors
Dr. David McCartney
Scottish Context (or whit ye need tae ken)
1.Do People Get Better
2.What is recovery?
3.What is the evidence?
4.How Does Recovery Happen?
5.Social influence, visibility and contageon
1. “Scotland - we are a small country with a big problem”
Pop 5.3 million
54,000 problem heroin users
Twice rate of England and 5 x that of US
22,000 on methadone
584 drug related deaths in 20011
Costs 3.5 billion pounds ($5.4 billion)
34% of men and 23% of women drinking to excess (self report)
5% of pop dependent on drink
Cirrhosis rates have doubled
Vast majority of liver cirrhosis deaths are related to alcohol
Enormous increase in alcohol related mortality
Alcohol related deaths - high related to neighbours.
It’s multifactorial causation
Change in perception - unacceptable to be seen drunk in public in my granny’s day where as today any weekend night you’d see lots of people drunk in street
Supermarket spirits
Price of alcohol falls and alcoholism rises
  1. Do people get better?
“Saw administrator in Scottish harm reduction facility and told that if you want to succed in this work you have to believe no one will get better.”
“I decided not to work there.”
Desistance (crime)
Belief nothing works
-85% of repeat offends desist from criminality by the age of 28 (Blumstein and Cohen 1987)
Recovery rates
-CSAT (2009)  58% of life course dependent users of substance will achieve lasting recovery
-Bill White (2012 50.3%
-Welsh workers estimate 7% (Best)  - asked the addiction workers and this was their idea - this is the “Clinical Fallacy”.  Major gap between reality and belief
Outcomes (US) physicicians
80% pluse sustained abstinence
70% return successfully to work
High expectation
Intensive treatment
Outcomes (UK) physicians
79% abstinence (at 3 years)
Most return to work
Most avoiding GMC (Boards)
Unlike their patients most opiate addictied physicians don not end up on opiate replacement therapy
Lothians and Edinburgh Abstinence Programme
  • positive residential treatment program, medical and social, 3 months
  • funded at point of contact through NHS
Seven Pillars of LEAP
-housing (safe, supported)
-mutual aid/recovery community
-family programs
-aftercare  (2 years)
This is fairly new in United Kingdom
300 referrals/year
 112 admissions/year
62% completion
52% graduates maintain abstinence (one year)
Do people get better?
Duration of Recovery
(Bill White 2013)
When does recovery today predict recovery for life
Point of durability seems to be reached by 4-5 years of recovery -stay sober and clean for life
What is Recovery?
-voluntarily sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society - UK Drug Police Commission - 2008 p6
-Recovery is a process through which an individual is enabled to move on from their problem of drug abuse towards a drug free life and become an active and contributing citizen -
Betty Ford - sobriety, personal heallth and citizenship.
You are in recovery if you say you are - valentine - abtinence alone is not recovery
Evidence Review
There is little UK based research and international evidence base on recovery is limitted by 3 factors
  1. dated 
2. much is based on alcohol and not illict drugs
  1. much of it was US
Sustatined recovery ‘is the norm”
Recovery is related to the 12 step process
Study of workers in the field in recovery from heroin addiction (108)
‘tired of lifestyle, found rock bottom, 
why did they stay stopped
-moved away from using networks
-found treatment not that important
Mapping the recovery journeys of former drinkers (Hibbert and Best (2011) Drug and Alcohol Review)
  • physical health
  • psychological health
  • environment
  • evidence - in early recovery - first 2 years a little lower than society norms
  • “BETTER THAN WELL RESEARCH” after 5 years appear to do better than the population norm. 
Post Traumatic Growth
-from natural disasters like tornadoes, plane crashes murders( McMillan 1997) , sexual assault (Frazier 2004) 
-pain touchstone of spiritual recovery and growth
How does recovery happens
Several models
  1. Social control
  2. Social Learning
  3. Stress and Coping
  4. Behavioural economics 
Structural equation modelling results
over 2000 patients
Self help movement involvement - active coping, motivation to change, friendship - all contribute to substance reduction.
"Getting you plugged in makes you well"
Holt-Lunstad & Colleagues (2010)
Grella and colleagues (2008)
Best and Laudet (2010)
*Number and quality of social relationships predicted long and healthy life
People who relapsed were less likely to use self help movement
Community benefit - increased non using relationships
Lit et al “changing network support for drinking (2009)
-one abstinent person in network decreased risk of relapse by 27%
Recovery studies in Birmingham and Glasgow (n=205)
-more time with other people in recovery
more time in activities.
Recovery Capital
-breath and depth of internal and external resources that can be drawn on to resist alcohol and drug abuse
  • can increase ‘recovery capital’ 
  • clean housing, friends, family ,health, volunteering, peer support, work
  • new concept in UK - assertive referral to mutual aid
  • - mostly getting people on to AA/NA
  • -find out what meetings are available
  • hard to get professionals to believe this and do this despite all the evidence that this work
  • less than 5% will respond with just a brochure
  • need to have someone meet them and go with them and ask about the meeting in follow up
  • 1,200 groups weekly
  • various family and servicers groups
How are we doing in Edinburgh (The Gap)
Do you or have you ever used AA/Na
AA- .8%
NA - .4%
 Part of it is the misperception about the success  - self help recovery is very successful
Clinical fallacy exists that recovery isn't successful mainly because - we don’t see those who get well
Misperception it’s an religious group
Alcoholic Anonymous in UK
  • all the mutual aid groups are growing and some very rapidly
Social Influence and Contagion
-"hang around recovery people long enough and you might catch a dose of recovery"
  • same is true with addiction
Framingham Heart Study - Christakis and Fowler
-person’s odds of becoming obese increased by 57%
(similar research with smoking -if your partner stops smoking 67% increased chance you will)
-Conclusion ‘your friends can make you fat’
Obesity Epidemic
64.3% Scots obesid
“obesity is catching’
Social learning and Social Control
Social Network and quality of life
-Holt-Lunstad - 2010 - individuls with good social networks 50% greater likelihood of survival
12 step affiliation versus involvement
  • **attendance at 12 is not likely to be as helpful as becoming actively involved
  • ***getting a sponsor at 6 months 4 fold likelihood of not relapsing
“My recovery gave me a new life”
-recovery from addiction makes Scotland stronger”
-visibility important
Recovery communities 
outside mutual help
UK Recovery Walk
relationship between treatment and recovery
  • treatment can be a part of recovery ‘initiation’
  • gives the client the tools - managing your own recovery
  • -self efficacy and enduring recovery (recovery maintenance)
  • a journey, not a destination
  • eg diabetes and emphysema - movement to training patient to manage their own 
illness from original management plan of solely seeing speciality
  • have treatment providers got it the wrong way round?
  • Recovery is contagious
  • Reocvery champions
What does it all mean?
  1. Recovery is a reality - evidence - recovery narratives
  2. Recovery is social - takes place in 12 step groups
  3. Recovery is contagious - attraction, power of example
  4. Worldwide evidence base needs to develop a  bit - 12 step evidence is strong and growing
  5. We can actively connect people to recovery resources ( 

1 comment:

Suzanne F. said...

Maybe you should make a blogpost out of this-- with sentences and paragraphs. This is very interesting.