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.

1. Prof. Dr. Wouter Vanderplasschen
Ghent University, Dept. Of Orthopedagogy
Wouter.Vanderplasschen@UGent.be

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?

4. 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;

5. 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

6. 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

7. 2. Treatment and prevention:
intervening at the right moment
Interventiespectrum voor psychische stoornissen (naar Mrazek en Haggerty, 1994)
Vroeginterventie
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8. Universal, selective and indicated
prevention
Universal
Selective
Indicated

9. Three types of prevention – Mrazek &
Haggerty
Universal – the whole group
Selective – vulnerable groups
Indicated – vulnerable individuals

10. Prevention: filtering
Skill training in
schools (e.g.
Unplugged)
Adapted
interventions for at
risk groups
Risk of
stigmatisatio
n
Coping with
impulsivity

11. Treatment
Outpatient drug-free Tx
 Substitution Tx
 Harm reduction services

Detoxification
 Residential rehabilitation
 Aftercare – continuing care


12. 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

13. 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

14. 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

15. Course of substance abuse
treatment?
8
7
6
5
Ernst problemen
4
X1
3
2
1
0
Pre
T1
T2
T3
Post
Verloop behandeling

17. 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”)

19. 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)

20. 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

21. 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).

22. 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.

23. (Leamy, Bird, Le Boutillier, Williams & Slade, 2011)

24. 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

25. 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

27. Scientific evidence on exaddicts & treatment

29. 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!

30. 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)

31. 
Thank you for your attention?

Wouter.Vanderplasschen@UGent.be