Contagious and Visible Recovery – Mark Gilman

Over recent years we have seen three phases in the modernisation of treatment for Substance Use Disorder (SUD) in England. The first phase saw waiting times eradicated and the numbers of people entering treatment increased to unprecedented levels. The second phase was to retain as many of these people in treatment long enough for the treatment to have an effect. The third and final phase is recovery. In essence, this is the process by which people successfully complete and leave bio-medical and psychotherapeutic treatments and engage in social networks. Recovery is a social activity. This is seen in the slogans associated with recovery; “I can’t but we can”, “You alone can do it but you can’t do it alone”. Public health colleagues recognise the importance of social relationships in the prevention of premature mortality (dying too early).

“Social relationship– based interventions represent a major opportunity to enhance not only the quality of life but also survival” Holt-Lundstad et al 2010 p.14

From this perspective, the quality of the recovering person’s social relationships is a matter of life or death. On their own, people with a serious SUD tend to die before they recover. This is the brutal truth of recovering from SUDs. By connecting with a positive social network people with SUDs may live long and happy lives that are joyous and free. Until the publication of Public Health England’s facilitated Access to Mutual Aid (FAMA), going to Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) or any other form of mutual aid was seen as an optional extra. Something you might want to do but was seen as largely irrelevant by many or most SUD treatment professionals in the UK.

The adoption of ‘assets based approaches’ reminds us that the biggest assets in England (and everywhere in the world) are the anonymous 12 step fellowships; the more secular and scientific alternative SMART Recovery and Acceptance and Commitment Therapy (ACT) delivered in groups as a new form of mutual aid. ACT Peer Recovery (ACT PR) offers a very wide open door to mutual aid with a very low threshold. ACT PR is all about behaviour. What we think and feel is important but it’s what we do that matters most. If all we had to do to recover was to talk about recovery we could all have gone home decades ago. People with a SUD can talk great recovery but recovery communities are being established by people who have changed how they behave. Our behaviour as people in recovery models the behaviour of others and we learn together how to gain the power necessary to overcome all of our damaging addictive behaviours.

Successful recovery from a SUD is about moving through the narrow corridor of clinical healthcare services into the wide world of positive social relationships. Recovery is constructed with others in communities of recovery or recovery communities. Recovery happens in geographical places. This website is designed as a showcase and connection point for all those involved in making their communities places where recovery can be started and sustained.

Written in the late 1930s, the book of Alcoholics Anonymous (aka ‘The Big Book’) describes the recovery process like this:

“We are people who normally would not mix. But there exists among us a fellowship, friendliness, and an understanding which is indescribably wonderful. We are like the passengers of a great liner the moment after rescue from shipwreck when camaraderie, joyousness and democracy pervade the vessel from steerage to Captain’s table. Unlike the feelings of the ship’s passengers, however, our joy in escape from disaster [addiction] does not subside as we go our individual ways. The feeling of having shared in a common peril [addiction] is one element in the powerful cement which binds us. But that in itself would never have held us together as we are now joined. The tremendous fact for every one of us is that we have discovered a common solution.” (2)

This statement is given contemporary relevance by the work of Robert Putnam in his books “Bowling Alone” (3) and “Better Together” (4). Putnam draws our attention to the limitations of ‘bonded social capital’ and the possibilities offered by ‘bridging social capital’. Meetings of anonymous 12 step fellowships are, at their best, examples of ‘bridging social capital’ in action. Places where working class and middle class addicts meet on common ground with the common purpose of helping each other in mutual aid.

“The sense of mutuality that we feel for one another that expresses itself in trust and care…Your good being bound together with my good.”

It is in these meetings that socially isolated and disadvantaged ‘addicts’ and ‘alcoholics’ often find jobs, homes and friends. Recovery communities are based in places in geographical entities. I have recently moved from Bury to East Lancashire. The difference in the recovery communities is stark. I have yet to go into Burnley town centre without bumping into someone in recovery. This was not my experience in home town of Bury. Recovery is much more visible in the towns of East Lancashire than it is in Bury.

Advising on the construction of geographical recovery communities offering a ‘common solution’ in each of the 152 local authorities is one of the tasks facing Public Health England and the new national Recovery Champion. Recovery communities are built using an Asset Based Community Development (ABCD) approach. The 12 step fellowships, SMART Recovery, ACT Peer Recovery and faith based mutual aid are the most obvious assets that form the nucleus of these recovery communities. Public health’s recognition of the importance of social relationships casts mutual aid groups in a new and ever more important light. Viewed from the narrow perspective of clinical healthcare services and medicine, the importance of mutual aid groups has often been dismissed or seen as an optional added extra. This is no longer the case. Assertive linkage to mutual aid and other positive social networks is every bit as important as the bio-medical and psychotherapeutic treatments. This is now recognised by commissioners and providers of substance misuse treatment services. As these recovery communities grow, recovery will become ever more visible and contagious. The primary purpose of this website is to promote recovery places. Please get involved and put your recovery place on the map. Together we can change the face of recovery by building and promoting recovery places.

  1. Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316. doi:10.1371/ journal.pmed.1000316 page 15
  2. Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services. page 17.
  3. Robert Putnam “Bowling Alone”
  4. Robert Putnam “Better Together”

Mark Gilman
November 2017

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