Prof. Dr. Wouter Vanderplasschen
Ghent University, Dept. Of Orthopedagogy
Wouter.Vanderplasschen@UGent.be
Scope of this presentation


Plenty of anecdotal and clinical evidence that recovered
users make a difference in alcohol ...
1. Addiction, a shifting focus


Addiction is diagnosed as an individual problem with various social
implications (Americ...
Changing perspectives on „addiction‟
(Van den Brink, 2005)
1750 - now

Moral model

Prison, boot camps

1850 - now

Farmac...
Addiction, a shifting focus (Van
den Brink, 2005)


Brain imaging studies have shown that
addiction is a brain disease 
...
2. Treatment and prevention:
intervening at the right moment
Interventiespectrum voor psychische stoornissen (naar Mrazek ...
Universal, selective and indicated
prevention
Universal

Selective

Indicated
Three types of prevention – Mrazek &
Haggerty

Universal – the whole group
Selective – vulnerable groups
Indicated – vulne...
Prevention: filtering
Skill training in
schools (e.g.
Unplugged)
Adapted
interventions for at
risk groups
Risk of
stigmati...
Treatment
Outpatient drug-free Tx
 Substitution Tx
 Harm reduction services


Detoxification
 Residential rehabilitati...
Have we evaluated addiction treatment
correctly?! (McLellan, 2002)
-

Low compliance and high relapse rates among
addicted...
Was Tx successul in this case?
8
7
6

Ernst problemen

5
4

X1

3
2
1
0
Pre

T1

T2

T3

Post

Verloop behandeling
Course of medical Tx:
hypertension, diabetes, …
8
7
6

Ernst problemen

5
4

X1

3
2
1
0
Pre

T1

T2

T3

Post

Verloop be...
Course of substance abuse
treatment?
8
7
6
5
Ernst problemen
4

X1

3
2
1
0
Pre

T1

T2

T3

Post

Verloop behandeling
Have prevention and treatment
failed?


No, but we should be realistic (not pessismistic) about
our expectations and Tx o...
Addiction recovery


Recovery is increasingly studied in mental health research
and can be defined as:
 “The establishme...
Addiction recovery
 Recovery ≠ abstinence (Laudet, 2008; Fiorentine &

Hillhouse, 2001)
○ Recovery is a proces of persona...
Dimensions of recovery
 Clinical recovery; based on the invariant importance of symptomatology, social

functioning, rela...
Recovery capital
 Recovery has many pathways:
○ Recovery seen as an individual and personal journey, with a

unique path ...
(Leamy, Bird, Le Boutillier, Williams & Slade, 2011)
How to exploit recovery capital (Best,
2012)?


Process of recovery
 Recovery does not necessary involve treatment:
○ Na...
Towards recovery-oriented
systems of care (Best, 2012)


A noticeable growth towards recovery-thinking in
the field of ad...
Scientific evidence on exaddicts & treatment
A lot of potential that is not
used!




Abundant evidence that involvement of
recovered users is of surplus value
Chang...
Development of a recovery
movement in Belgium. Why?


To raise awareness that recovery is possible!




Sensibilistatio...


Thank you for your attention?



Wouter.Vanderplasschen@UGent.be
Presentation Wouter Vanderplasschen Rotary Brussels 21 09 2013
Presentation Wouter Vanderplasschen Rotary Brussels 21 09 2013
Presentation Wouter Vanderplasschen Rotary Brussels 21 09 2013
Presentation Wouter Vanderplasschen Rotary Brussels 21 09 2013
Presentation Wouter Vanderplasschen Rotary Brussels 21 09 2013
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Presentation Wouter Vanderplasschen Rotary Brussels 21 09 2013

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At the occasion of the 5th training seminar Addiction Prevention for Rotarians and partners, orgaized by Rotary Districts 1620, 1630 and 2170, Prof. Vanderplasschen presented the state of the art of the treatment methods for drug addiction and the possibilities to engage Recovered Users in treatment and addiction.

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Presentation Wouter Vanderplasschen Rotary Brussels 21 09 2013

  1. 1. Prof. Dr. Wouter Vanderplasschen Ghent University, Dept. Of Orthopedagogy Wouter.Vanderplasschen@UGent.be
  2. 2. Scope of this presentation  Plenty of anecdotal and clinical evidence that recovered users make a difference in alcohol and drug prevention & treatment      AA, NA, CO Drug-free therapeutic communities Life stories - prevention Role models, social learning, peer support, mutual help, … Only few A & D services make use of recovered users  Underutilisation of the strong potential of recovered users in alcohol & drug treatment services  How can we do better?
  3. 3. 1. Addiction, a shifting focus  Addiction is diagnosed as an individual problem with various social implications (American Psychiatric Association, 1994; Hser & Anglin, 2010), including a negative impact on public health, social cohesion and employement rates (McLellan e.a., 2000).  For a long time, a clinical approach of the concept 'dependence' was dominant:  Dependence as an acute condition, where short, intensive, symptom-oriented treatment should aim at achieving an abstinent lifestyle (Laudet & White, 2010).  Recovery as a set status, which requires abstinence.  Abstinence as THE way to cure from addiction.  Recently, addiction is more and more seen as a chronic, relapsing brain disease (Van den Brink, 2005).  Within addiction treatment the focus shifted from „cure‟ to controland stabilizing the problem (Hser & Anglin, 2010; McLellan, 2002;
  4. 4. Changing perspectives on „addiction‟ (Van den Brink, 2005) 1750 - now Moral model Prison, boot camps 1850 - now Farmacological model Ban on alcohol & drugs 1930 - now Symptomatic model Psychotherapy 1940 - 1960 Disease model Medication; AA 1960 - 1970 Behaviourist model Behavioral therapy 1970 - now Biopsychosocial model Multi-modal therapy 1990 - now Brain disease model Medical & psychosocial Tx
  5. 5. Addiction, a shifting focus (Van den Brink, 2005)  Brain imaging studies have shown that addiction is a brain disease   inborn vulnerability as basis for misuse of substances ~ repeated use of substances leads to changes in the brain  Craving is central in uncontrolled use and relapse during periods of abstinence.  Addiction chronic and relapsing disorder, of which recovery is possible
  6. 6. 2. Treatment and prevention: intervening at the right moment Interventiespectrum voor psychische stoornissen (naar Mrazek en Haggerty, 1994) Vroeginterventie tie f in g ehan el nd ha be d ar st an lec da e rd ge b ice unive vroe ïnd se ie ificat ident ge Preventie delin g Hulpverlening lan rsee g e rm et ijn b l rg / nazo zorg eh d an eli hte g e ri c ng Voortgezette zorg entie p re v
  7. 7. Universal, selective and indicated prevention Universal Selective Indicated
  8. 8. Three types of prevention – Mrazek & Haggerty Universal – the whole group Selective – vulnerable groups Indicated – vulnerable individuals
  9. 9. Prevention: filtering Skill training in schools (e.g. Unplugged) Adapted interventions for at risk groups Risk of stigmatisatio n Coping with impulsivity
  10. 10. Treatment Outpatient drug-free Tx  Substitution Tx  Harm reduction services  Detoxification  Residential rehabilitation  Aftercare – continuing care 
  11. 11. Have we evaluated addiction treatment correctly?! (McLellan, 2002) - Low compliance and high relapse rates among addicted individuals !? -  Less than 50% takes medication according to scheme Less than 30% follows behavioural guidelines(diet, …) 40-60% re-hospitalisation … Usually no remission after 1st treatment Still, not always chronical:  Recovery is possible, even without Tx  Long remission phase  Many persons do relapse, permanent vulnerabilty
  12. 12. Was Tx successul in this case? 8 7 6 Ernst problemen 5 4 X1 3 2 1 0 Pre T1 T2 T3 Post Verloop behandeling
  13. 13. Course of medical Tx: hypertension, diabetes, … 8 7 6 Ernst problemen 5 4 X1 3 2 1 0 Pre T1 T2 T3 Post Verloop behandeling
  14. 14. Course of substance abuse treatment? 8 7 6 5 Ernst problemen 4 X1 3 2 1 0 Pre T1 T2 T3 Post Verloop behandeling
  15. 15. Have prevention and treatment failed?  No, but we should be realistic (not pessismistic) about our expectations and Tx outcomes          Strong correlation between Tx dosage/length and outcomes Selection processes: motivation, right moment, … <3% abstinent after years of substitution Tx Transgenerational cycles of addiction and deprivation Costs < benefits in terms of crime reduction, economic participation, … Therapeutic alliance! Identification with counsellor Participation in AA – aftercare can enhance Tx outcomes Need for continuing formal and informal support Need for a recovery-approach  https://www.youtube.com/watch?v=bOMHz2-cGAQ (“20- 2‟20”)
  16. 16. Addiction recovery  Recovery is increasingly studied in mental health research and can be defined as:  “The establishment of a fulfilling, meaningful life and a positive sense of identity founded on hopefulness and self-determination” (Slade, 2010, p2.)    Recently, there is more attention for recovery in addiction research. However, no real consensus on the interpretation of the term (McIntosh & McKeganey, 2000; Maddux & Desmond,1986): Characteristics of recovery:  Recovery as a dynamic concept ○ Addiction characterized as a chronic relapsing condition ○ Substance users cycle between abstinence / period of less frequent use and relapses into active drug use (Dennis, Scott, Funk, & Foss, 2005). ○ Recovery is a process rather than an event (Best, 2012)
  17. 17. Addiction recovery  Recovery ≠ abstinence (Laudet, 2008; Fiorentine & Hillhouse, 2001) ○ Recovery is a proces of personal growth, which is not limited to substance use ○ Along problems regarding substance use, individuals experience serious health, social and economic consequences (McLellan, Lewis, O‟Brien, & Kleber, 2000) ○  Abstinence cannot be seen as THE defining element of recovery, but as one of the many ways to get to recovery (White, 2007). ○ Recovery without abstinence is possible!  recovery does not stop with symptom-reduction, the individual process of growth can still be going  Recovery is about achieving a contributing and satisfying life
  18. 18. Dimensions of recovery  Clinical recovery; based on the invariant importance of symptomatology, social functioning, relapse prevention and risk management. The focus is on achieving an abstinent life style (Slade, 2010; White, 2007; Van der Stel, 2012)  Functional recovery; focuses on the physical, psychological and social functioning of the individual.  Community recovery; focuses on the social position of the addicted individual and the prevailing stigma. The improvement of rights and the voice of addicted individuals is important.  Personal recovery; the lived experiences of individuals in recovery and it reflects the individually defined and experienced nature of recovery. Confidence, hope, motivation for change, … are seen as strengths which can lead to change. (Bradstreet, 2013; Leamy e.a., 2011; Vanderplasschen e.a., 2013)  The focus has mostly been on clinical recovery (Slade, 2010; The Betty Ford Institute Consensus Panel (2007)  However, personal recovery appears to be the driving force for understanding and realizing other types of recovery (GGZ Nederland, 2013; Van der Stel, 2012).
  19. 19. Recovery capital  Recovery has many pathways: ○ Recovery seen as an individual and personal journey, with a unique path and duration for every person in recovery (Best, 2012) ○ Initiating ~ sustaining recovery ○ Recovery needs support of other people, is a social process ○ Recovery capital is crucial at different stages of the recovery continuum (Best e.a., 2010; Laudet & White, 2008; Best & Laudet, 2010).  Personal recovery capital: personal characteristics and skills which can be supportive for recovery, such as specific competences, severity of dependence and style of attribution.  Social recovery capital: includes the social network of the individual and the extent to which the individual experiences support and acceptance from this network.  Community recovery capital: concerns the extent of support that is available within the wider community, such as housing, employment, training, treatment and self-help groups.
  20. 20. (Leamy, Bird, Le Boutillier, Williams & Slade, 2011)
  21. 21. How to exploit recovery capital (Best, 2012)?  Process of recovery  Recovery does not necessary involve treatment: ○ Natural recovery is possible  Great influence of social context  Importance of choice and self-determination  Personal and social resources (= recovery capital)  However, recovery and treatment should not be seen as alternatives, they are compatible  Treatment should include: ○ Active engagement with local communities ○ Links to those who can convey hope and belief that recovery is possible  Recovery is social ○ It does not happen in isolation ○ Significant effect of family members and friends on chance of relapse ○ „assertive linkage‟ to groups in active recovery  Demonstration that recovery is possible, by individuals further along the road of recovery is important
  22. 22. Towards recovery-oriented systems of care (Best, 2012)  A noticeable growth towards recovery-thinking in the field of addiction (policy and practice) is seen in the US and the UK.  The Barnsley „case‟: ○ Recruiting „recovery champions‟  Strategic: managers to clarify the vision and model  Therapeutic: changing practices, attitudes and belief  Community: people in recovery, family members and others from the local community who need to motivate and inspire recovery activity ○ Engagement of „emerging recovery champions‟  Raising awareness in all key stakeholders  Creating a recovery coalition  Establishing a vision for recovery  Attempting to communicate that vision
  23. 23. Scientific evidence on exaddicts & treatment
  24. 24. A lot of potential that is not used!   Abundant evidence that involvement of recovered users is of surplus value Change is needed towards a recovery approach  We need to do more than providing substitute drugs!  Treatment is not enough to recover, ongoing support is needed to deal with the challenges associated with this chronic disorder  Not only about individuals, but about their surroundings and communities who also suffered from addiction problems  We need to support addicted individuals‟ to realized Connections, Hope, Identity, Meaning and Empowerment in their lives: RECOVERY!
  25. 25. Development of a recovery movement in Belgium. Why?  To raise awareness that recovery is possible!   Sensibilistation through media, community activities and organisation of events To recruit „recovery champions‟ that can support peers in various stages of the addiction process  Prevention, treatment, but foremost in continuing care To disconnect recovery and treatment, as there are many pathways to recovery  To advocate for substance users‟ rights and social position  To link with international networks and similar organisations:   RUN (Recovered Users Network)
  26. 26.  Thank you for your attention?  Wouter.Vanderplasschen@UGent.be

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