Mark Gilman - Public Health England


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Mark Gilman - Public Health England

  1. 1. Public Health Recovery and Families Mark Gilman Strategic Recovery Lead Public Health England
  2. 2. 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
  3. 3. 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
  4. 4. What‟s the problem in your family? “Addicts” “Alcoholics” Heavy User Binge Drinker/User SOCIAL Drinkers and Users Abstainers
  5. 5. 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”
  6. 6. Features of their involvement: bio-psycho-social Biological Psychological Social
  7. 7. What kind of substance problem?  Binge Drinker/User?  Heavy drinker/User?  “Alcoholic”? Alcohol “Addict”?
  8. 8. What do different types need to do? Bingers Get a different hobby Heavy Users Control your drinking Keep a drink diary “Alcoholics” “Addicts” Stop & Stay Stopped
  9. 9. Abstinence as a basis for Recovery from Addiction? “…because you have to turn the water off to mend the plumbing”
  10. 10. “Alcoholics” and “Addicts” Controlled Drinking/Recreational Use? “…down to one beer a day now!”
  11. 11. Right! I’m In Treatment but Socially Isolated? • I‟m alive • I‟m not in prison • But, I‟m alone… • I‟m HIV free
  12. 12. “Alcoholics” & “Addicts” alone & thinking: “I will only drink good red wine!” “I’ll just buy a bag on pay day!”
  13. 13. CONNECT? Groups? Mutual Aid? Nah! I can do it on my own! “I'm not getting in that lifeboat me!” “Keep rowing people!”
  14. 14. Bio-Medical and Psychological Treatments + Positive Social Networks Treatment •Positive Social Network •Recovery Community BIO PSYCHO SOCIAL
  15. 15. 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
  16. 16. Positive Social Network PHE Endorses Mutual Aid (MA) BUT PHE does not endorse any MA „Brand‟ MA Brand X MA Brand Y MA Brand Z
  17. 17. REDISCOVERING ALCOHOLICS ANONYMOUS “There is a Solution we know How it Works” POSITIVE SOCIAL NETWORK “You alone can do it but you “I can‟t but WE can” cannot do it alone”
  18. 18. 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”
  19. 19. AL ANON MUTUAL AID FOR FAMILIES AND FRIENDS “None of these guys are staying sober!” “But you are Bill!” (Al Anon is born)
  20. 20. '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
  21. 21. 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
  22. 22. Recovery does slowly what drink, drugs & medications do fast... ...changes perception of reality. Learning how to fit in “Community as method” To live life on life‟s terms Recovery community a place where you learn how to live Free from right, with other people... addiction Free from fear Al Anon & Famanon
  23. 23. “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?” „Goodbye, Mr. Wonderful‟ (Chris McCully 2004)
  24. 24. “I preferred you when you were…” Dear Chris, page 71…
  25. 25. 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