Mutual aid and its facilitation
Steve Taylor, Alcohol & Drugs, PHE
10 April 2013
Why social networks matter
Meta analysis: comparative odds of decreased mortality
Source: Holt-Lundstad et al 2010
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Five ways to wellbeing
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NICE
“routinely provide people who misuse drugs with
information about self-help groups.”
“consider facilitating the person’s initial contact
with the group, for example by making the
appointment, arranging transport, accompanying
him or her to the first session and dealing with
any concerns.”
NICE CG51, 2007
• Echoed in quality standard (QS23, 2012)
• And similar for alcohol (CG115, 2011)
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Recovery Orientated Drug Treatment
What?
“Strengthen or develop patients’ social
networks, involving families where appropriate
and facilitating access to mutual aid by, for
example, providing information, transport, or
premises for meetings, and by bringing local
recovery champions into the service to meet
patients.”
When?
In every phase of treatment and beyond
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NTA/PHE recovery resource
Helping clients to access and engage with mutual
aid
“Treatment providers and keyworkers who actively
help service users to access and engage with
mutual aid are likely to see better outcomes. But it
means doing more than simply providing
information or hosting meetings…”
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Who recovers?
• Everyone CAN recover
• Not everyone WILL recover
• We don’t know WHO will recover
• So, give everyone EVERY a chance
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Is it effective?
Effectiveness
• Improves substance misuse outcomes (NICE, 2007, 2011, 2012)
• Extra effect when combined with structured treatment (Fiorentine &
Hillhouse, 2000)
• The addition of just one abstinent person to a drinker’s social network
increased the probability of abstinence in the next year by 27% (Litt et al.,
2009).
Cost-effectiveness
Over 3 years per-person treatment costs for AA group:
• 45% lower than ‘professional’ treated groups with similar outcomes
• Mutual aid (AA) reduces on-going treatment costs (Humphreys, 2004)
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Mediators of effectiveness
How specific are the mediators of AA's effectiveness?
"Changes in active coping behaviours, cognitive appraisal of the advantages
and disadvantages of drinking, and self-efficacy may seem more the stuff of
cognitive-behavioral psychotherapy than of a 12-step self-help organization.
But even the most spiritually minded AA meetings and texts offer extensive
practical advice, which any cognitive-behavioral theorist would endorse even
though the jargon would be unfamiliar”
Circles of Recovery, Keith Humphreys
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Mediators of effectiveness
How specific are the mediators of AA's effectiveness?
CBT
12-step
monitor for relapsepromoting cognitive
distortions
no stinking thinking
adopt behavioural changes
that are congruent with
more positive mood
fake it until you make it
use stimulus-control
methods to eliminate
alcohol consumption
avoid slippery people,
places, and things
Circles of Recovery, Keith Humphreys
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Mutual aid April 2013
What can you do?
Learn about it
“There is a principle which is a bar against all information, which is proof
against all arguments, and which cannot fail to keep a man in everlasting
ignorance - that principle is contempt prior to investigation.”
Attributed to Herbert Spencer (in Alcoholics Anonymous: The Story of How More Than
One Hundred Men Have Recovered From Alcoholism), after William Paley 1794
• Read
• Watch
• Learn
• GO!
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What can you do?
Host/promote/support meetings
• Provide space
• Provide literature
• Bring in speakers
• Use peer mentors and recovery champions
• Remind people about their meetings
• Escort them
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What can you do?
Synergise attendance
• Include in care planning
• Reflect in keywork
• Journal
• Maps
‘3-Step Referral Method’:
• Handouts, worksheets, research and guides available from
www.mentalhealth.va.gov/providers/sud/selfhelp
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Recovery Resources
http://www.nta.nhs.uk/recovery-resources.aspx
Helping clients to access and engage with
mutual aid:
www.nta.nhs.uk/uploads/rr_facilitatingmutualaid
_jan2013[0].pdf
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