1. Public Health
Recovery and Families
Mark Gilman
Strategic Recovery Lead
Public Health England

3. 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

4. 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

5. What‟s the problem in your family?
“Addicts”
“Alcoholics”
Heavy User
Binge Drinker/User
SOCIAL Drinkers and Users
Abstainers

6. 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”

7. Features of their involvement: bio-psycho-social
Biological
Psychological
Social

8. What kind of substance problem?
 Binge Drinker/User?
 Heavy drinker/User?
 “Alcoholic”? Alcohol “Addict”?

9. 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

10. Abstinence as a basis
for Recovery from Addiction?
“…because you
have to turn the
water off to mend
the plumbing”

11. “Alcoholics” and “Addicts”
Controlled Drinking/Recreational Use?
“…down
to one
beer a
day
now!”

12. Right! I’m In Treatment but Socially Isolated?
• I‟m alive
• I‟m not in
prison
• But, I‟m alone…
• I‟m HIV
free

13. “Alcoholics” & “Addicts” alone & thinking:
“I will only drink
good red wine!”
“I’ll just buy a bag
on pay day!”

14. CONNECT?
Groups?
Mutual Aid?
Nah! I can do it on my own!
“I'm not
getting in that
lifeboat me!”
“Keep rowing
people!”

15. Bio-Medical and Psychological Treatments
+ Positive Social Networks
Treatment
•Positive Social
Network
•Recovery
Community
BIO
PSYCHO
SOCIAL

16. 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

17. 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

18. 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”

19. 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”

20. AL ANON
MUTUAL AID FOR FAMILIES AND FRIENDS
“None of these guys are staying sober!”
“But you are Bill!” (Al Anon is born)

21. '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

22. 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

23. 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

24. “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)

25. “I preferred you when you were…”
Dear Chris, page 71…

26. 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