3rd Annual Correctional Services Healthcare Summit 2012

Can a ‘new recovery’ drug

treatment paradigm be

applied through

corrections? John Ryan

Presentation structure

Background on recovery emergence

Anex actions and views

Social and ‘recovery’ capital. Who would disagree?

Correctional settings: potential – in theory.

Background

Recall Australia - Road to Recovery 2003 paper

‘Recovery-oriented systems of care’ is a US-born concept

Signs from United Kingdom, Liverpool Conference 2010

Now official policy in UK, including with regard to Corrections.

Basics

‘new recovery’ is rooted in US traditions of mutual-aid groups

abstinence remains a dominant goal, and is included in the most high profile definitions.

– Eg: Betty Ford Institute.

Big emphasis on better connected ‘case management’ of people pre/post ‘treatment’

Evidence base – systems level - not strong.

Basics

Systems-level transformations toward recovery-oriented approaches are time-consuming and require substantial resourcing.

Recovery-oriented strategies within demand and harm reduction strategies do provide opportunities

Provided there is carefully thought-through adaptation and the underpinning principles and definition are established clearly.

Recovery as a ‘movement’

Activists identify organisational principles, strategies and tactics.

“The current generation of recovery advocacy groups are among the first to utilize theoretical models of social change to guide their development of strategies and tactics, e.g., Gandhi, King, Alinsky, Freire.” – White 2000

He outlined a quasi manifesto. Recovery Academy and recovery walks are part of the strategy – they are a tactic.

Social and ‘recovery’ capital

Housing

Physical and mental health

Purposeful activity; education, training and employment

Peer support

Family and friends

Extremely logical. But for many elusive.

Anex views and action

Definitely NOT against recovery if adapted.

Forthcoming Victorian Whole of Government strategy – obvious

Anex Tactic

– to take stock, consider carefully, caution Government about headlong rush to unknown systems

Preserve harm reduction recognition and services

Additional principle after feedback:

Because each individual must choose for themselves the most appropriate path and technique of recovery, there is no justification for forms of prescriptive public policy in this area.

Global and local feedback

“In consideration of some of the implications of a ‘New Recovery’ model being introduced in Australia we feel it is imperative to have a definition of recovery that aligns with current policy, service provision, and a harm reduction philosophy.

Any definition needs to address the difference between the notion of ‘clinical recovery’ and ‘personal recovery’

Victorian Dual Diagnosis Initiative Rural Forum

Proposed definition

“Recovery is a voluntary self-determined process toward wellbeing through minimisation or cessation of drug-related harms. This involves fostering healthy supported connections, such as with self, family, peers and community, and is premised upon fair access to pre-requisites for wellbeing.”

BIG WIN - Vic. Roadmap 2012

“Recovery sits within a framework of harm minimisation that recognises people come to treatment through many different paths and that their goals and their journey towards recovery and wellbeing are individual and unique.”

Harm reduction within ‘recovery’

Source: New directions for alcohol and drug treatment services: A roadmap. Victorian Government, 2012

Harm Reduction and Justice Services

Gallagher’s ‘principles’

“Principles demand that we must see beyond the labels …..”

“.. the right to the same health-care options and opportunities, the same culture of care …

“public-health outcomes … ought to be no different, no less”

Potential for corrections

ACT developments as step toward recovery paradigm

a) Strong diversion programs.

b) Increased treatment options in AMC (theory)

c) Promised action on BBV testing and treatment

• Naloxone program. Definitely recovery-oriented.

• Proposed needle exchange. • Albeit ‘minimalist’ one-for-one with arguably little immediate

BBV impact.

• Strong signal. Hope-oriented.

• IRID – hope for less brutal injections due to blunt needles

Pilot opportunities in prisons

Recovery capital foundations potential

– ‘place to live’

– meals;

– Potential for mutual aid groups

– Some structured daily activities, including forms of work, study etc

– Potentially pre- and post-release linkages with services

Recovery will take long time to understand and integrate.

– Opportunities in prison-settings for trials and adaptation

Conclusions

Weak evidence-base - wholesale shifts - involves significant risks.

Without serious localisation potentially quite dangerous.

Corrections reform is always on-going – change is increasingly expected.

If can’t work in corrections, what hope elsewhere?