Prof John Stoner

CSARS GroupUniversity of Chester

WREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT (WRAPP)

WRAPP: a partnership Twelve Step Facilitation (TSF) pilot project funded by Welsh Government delivered on behalf of the North Wales Area Planning

Board

PARTNERS: Wrexham County Borough Council, Substance Misuse

Advisory Team (WCBC SMAT),AVOW - Association of Voluntary Organisations in

Wrexham CSARS Group, University of Chester.

WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT (WRAPP)

“Perfect Engagement” Consultation Event

14th February, 2013, Wrexham

Hosted by WASUP (Wrexham Alliance Service User Partnership) on behalf of AVOW

SERVICE USERS’ REQUIREMENTS AND SERVICE PROVIDERS’ RESPONSE

Recognition of users’ low Recovery Capital and self- esteem, they feel unsupported

Accommodation – housing, hostelsEducation, training and employment Inadequate and unaff ordable transportPoor communication between individual service

providers and usersCurrent services are seen as bureaucratic and

unresponsive to users’ needsLack of treatment (rehab, detox), out-of-hours and

aftercare servicesStrong preference for support workers in recovery

themselves – they “understand”

SERVICE USERS’ REQUIREMENTS

Aftercare support and services to be developed (Resources?)

‘Out of hours’ support to be developed (Resources?)

Review need for paperwork and engage more with service users (Progress?)

 Monthly Service Provider Delivery meetings.

To work towards a consensus of what Service User involvement means to Providers and Service Users

SERVICE PROVIDERS PRIORITY RECOMMENDATIONS

Recovery services (rehab, detox, aftercare)Support for individual service usersLinking to mutual-aid groups

Adapted from the Perfect Engagement Report, 2013

Progress review in June 2014

LIKELY SHORTFALL IN SERVICE PROVISION

“More rigorous evidence in support of AA emerging in the past 20 years, in particular, has moved AA from a peripheral status to playing a more central role in a recovery-oriented system of care …. Stemming from these findings on AA’s broad reach, eff ectiveness, and cost-eff ectiveness, professional interventions have been developed and tested, designed specifi cally to engage patients with these community mutual-help resources during and after treatment. These “Twelve-Step Facilitation” (TSF) interventions have been found to enhance patient outcomes in randomized controlled investigations.”

(John F. Kelly & William L. White, 2012 )

ADDRESSING THE SHORTFALL: COOPERATION AND TWELVE STEP FACILITATION

Making Alcoholics Anonymous (& NA) Easier

developed byLee Ann Kaskutas and Edward Oberste

Alcohol Research GroupBerkeley, CA 94709

TSF: MAAEZ MANUAL

Facilitating participation in AA/NA Preparing clients for transition into

AA/NA cultureAddressing some of the myths about

AA/NAExplaining how AA/NA helps and

operatesProviding a safe group for individual’s to

exchange experiences

MAAEZ OUTCOMES & OBJECTIVES

Supporting a group of 20 people with substance-misuse problems and wanting to achieve abstinence-based recovery.

Introducing the participants to the principles of 12-Step recovery programmes and local mutual-aid groups such as AA and NA.

Providing support for participants in early recovery

Providing training to improve staff awareness & understanding of 12-Step recovery programmes & groups (40 staff)

WRAPP: PROJECT AIMSWREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

Tony Ormond – Service User Involvement Coordinator, AVOW

Tim Roberts - Project Offi cer, CSARS Group, University of Chester & AVOW Volunteer. Formerly

Rhoserchan & Park View Treatment Centres

Jim B – AVOW Volunteer & AA liaison John Stoner - Visiting Professor & Co-Director of CSARS

Group, University of Chester, Professorial Research Fellow, Centre for Research into Environment and Health, University of Aberystwyth,

Formerly Rhoserchan Treatment Centre

We gratefully acknowledge the support of key staff and the cooperation of AA & NA

WRAPP: PROJECT TEAMWREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

A four-month project December 2013 – March 2014, compressed due to delays in funding approval.

Recruitment took place in December/January and the programme ran from January – March 2014.

Staff training events held in late January & March

Participants were supported through a weekly programme of WRAPP activities comprising workshops, group sessions and facilitated attendance at local AA and NA meetings.

)

WRAPP DELIVERY WREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

Twelve-Step Approaches to Recovery and Engagement with Mutual – Aid Groups

Government Policy, Service User Requirements and Resources Available

Twelve Step spirituality (Higher Power Project)AA/NA Members’ Shares on their experience,

strength and hope of recoveryWRAPP Preliminary Outcomes Delegates were also offered the opportunity of

accompanied attendance at local AA/NA meetings.

60 attendees, 36 feedback questionnaires

WRAPP: STAFF TRAINING EVENTS WREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

Some Perceptions of AA/NA Before Training Support for people. Don’t know anything about them. Religion based (structured) groups. America, Christian

based ethos. Advantages - Holistic approach, the persons responsibility,

it’s cheap. Disadvantages - its image may be off putting. Mixed, (Advantages) I realise that all of the above have

helped people turn their lives around who would not have survived, (Disadvantages) but I worry that the dependency on the group simply replaces the dependency on the drug / alcohol

My Straight Head – acceptance, recovery: My Cynical Side – stigma, god, higher power, forced down your throat:

Advantages – fellowship, sense of belonging/ community support. Disadvantages – Abstinence is not for everyone, can become over dependant and Evangelical.

How informed have referrals to AA/NA been?

WRAPP OUTCOMES: STAFF ATTITUDES

WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

Some Perceptions of AA/NA After Training

… spiritual / religion and diff erent understanding. … only disadvantages are the religious image and the life long fi ght.

BUT loads of pluses, eff ective increased wellbeing and health, abstinence and wellbeing.

Changed a lot, you have shown me a lot and I have a lot more feelings and opinions about AA and NA.. I understand the 12 steps more now

Hearing personal stories and how people have tackled their problems, as well as beating some myths through the day have helped me (appreciate) the benefi ts of these groups

Good support network for people, more awareness and better understanding, the stories helped

Support system for life- after detox and rehab centres and treatment units. Has politics as all interventions do, but works well with open door policy

Radical changes are needed to change the concept of AA and NA, I understand better what is needed to improve the profi le

I just wish that judges where able to order people to go and that there was less stigma attached to admitting you are an addict or alcoholic.

WRAPP OUTCOMES: STAFF ATTITUDES

WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

Attendance at AA/NA MeetingsBefore Training:83% (30) had never attended a meeting

After Training:78% (28) said that they intended to

attend a meeting14% (5) have subsequently attended

meetings accompanied by AA/NA members

Follow-up required to encourage/facilitate attendance

WRAPP OUTCOMES: STAFF ATTITUDES

WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

Client Referrals to Mutual-Aid Groups AA/NA Before training:22% (8) Never11% (4) Rarely17% (6) NA

25% (9) Sometimes, when appropriate25% (9) Regularly/routinely

After training:94% (34) intend referring clients, many with

enthusiasm

Follow-up required if this intention is to be translated into positive referrals

WRAPP OUTCOMES: STAFF ATTITUDES

WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

Following accompanied attendance at an AA/NA Meeting:

I d id enjoy the meet ing last night , i t gave me a huge insight into people's exper iences and the diffi cult ies a lcohol ics have to overcome everyday which we would take for granted.

I wil l try and persuade people who I come across that there is hope and spread the word of AA and the other fellowships out there . I was impressed by the support you al l g ive each other and "got i t" I f you know what I mean! Susan Carr ington ASB Offi cer North Wales Pol ice  I found it hugely uplift ing and the experience was one of warmth,

acceptance and support that is unrivalled by anything that I have been involved with before.   I t ru ly feel honoured to have seen a fel lowship in act ion, so thank you.

V icky Jones, Performance Improvement and Partnerships Manager, Wrexham CBC

 

WRAPP OUTCOMES: STAFF ATTITUDES

WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

Following accompanied attendance at an AA/NA Meeting: I could not believe how welcomed and relaxed I felt.

The people were so open, honest and accepting of everybody. From a commissioning perspective it made me realise that we need to think carefully about how and by who services are best delivered. It also made me think about how we get more people to engage with groups like this, we would welcome any advice you can give.

Shirley Jones, Supporting People Manager

Thank you for supporting me to attend last night’s meeting, I found it very insightful.

Dawn Lewis, Community Diversity Offi cer, Wrexham CBC

WRAPP OUTCOMES: STAFF ATTITUDES

WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

Experience to date suggests that there have been significant awareness and resistance issues towards 12-Step recovery amongst local staff involved with substance misuse issues.

Low referral rates to WRAPP from other agencies – 11

people referred, only 5 attended for assessment.

The remaining participants found WRAPP through word of mouth, publicity, a service-user event and personal contact with service users by WRAPP staff.

WRAPP OUTCOMES: RECRUITMENTWREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

Assessment criteria used at interview : - Duration of active addiction - Engagement history with drug & alcohol services - Willingness to change, attitude & behaviour - Perceptions/previous engagement with AA/NA - Physical / Social / Psychological mitigators - Emotional responses to structured recovery options - TOPPS and ARC assessment tools were used to augment weekly assessments of individual progress and change Candidates assessed: 19 Participants selected: 16 displayed some willingness

to change, but several had signifi cant health, other or motivational issues making completion of the course problematic.

WRAPP OUTCOMES: ASSESSMENTWREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

WORKSHOP SESSIONS

Registration and IntroductionAccepting Help and Twelve-Step SpiritualityChanging: Characteristics of Addiction and RecoveryChanging and Living in the DayLiving Clean and SoberManaging Emotions and Living with OthersRelapse Process and PreventionDeveloping Individual Recovery PlansReview Session: Living Sober and Relapse Prevention

Workshops supported by group and individual sessions

WRAPP WEEKLY PROGRAMMEWREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

Participants were supported to develop their own individual recoveries by trying to remain abstinent, undertaking homework, and integrating with local recovery groups and communities.

They were encouraged to independently attend additional AA/NA meetings and get involved with other local recovery activities.

AVOW provided support for participants generally and referred individuals to other services when appropriate.

WRAPP SUPPORTWREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

16 initial participants assessed weekly:7 (44%) completed the programme and are

making good progress. They have attended most of the WRAPP sessions, attend between 1 and 4 AA/NA meetings weekly and have engaged with local AA/NA members & groups, several have a sponsor.

9 (56%) attended between 1 and 3 WRAPP sessions and dropped out of the programme for a variety of reasons

Follow-up studies planned after 1 & 2 years

WRAPP OUTCOMES: RETENTION 1WREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

Of the 9 participants who dropped out of the WRAPP Programme:3 have since been in touch with us to let us know that

they are pursuing their own path of action within their fellowships

2 were able to get into detox during the running of the course

2 left because they felt they didn’t need it anymore

2 left and have not been contactable since

Positive outcomes for 75% of participants

WRAPP OUTCOMES: RETENTION 2WREXHAM RECOVERY FROM ADDICTION PILOT

PROJECT

Feedback from participants on the WRAPP Group:

WRAPP is a great support group that also gives you a foot into AA and after-support, which I feel I lacked the last time I attempted to stay sober.

I love the talking, sharing and debating in the group, it helps you to understand your own feelings.

IT’S NOT JUST YOU!

WRAPP is good and I have seen a diff erence in myself. Going to AA as part of WRAPP is good.

I have been sober for a while now and being in group has done me good – I think it would help other people too.

WRAPP OUTCOMES: FEEDBACK 1WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

Feedback from participants on their recoveries: It gave me a massive head-start. I got things quickly in

the rooms once I found them. I probably wouldn’t have found the rooms by myself anyway

I realise that I can have a happy, honest and good life without alcohol.

Two choices exist (for me): - A life of carnage, no family, no business, no friends, no future - A fulfi lling life with people I love and the possibility of a good futureAA and other support will help me keep sober

WRAPP OUTCOMES: FEEDBACK 2WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

The low WRAPP referral rates from most Wrexham agencies was disappointing but understandable.

Feedback suggests that staff training was eff ective in improving staff understanding of and future commitment to 12-Step recovery through mutual-aid engagement.

Despite recruitment problems, WRAPP has confi rmed TSF as a cost-eff ective intervention:

7 of 16 (44%)participants still engaged with the programme, a further 5 (31%) pursuing recovery through diff erent routesThere is considerable support amongst graduate

participants, partner organisations and local staff to build upon the success of the pilot project and develop a sustainable mutual-aid engagement project in Wrexham.

WRAPP OUTCOMES: LESSONS LEARNTWREXHAM RECOVERY FROM ADDICTION PILOT PROJECT

There is a requirement from government and service users for provision of a recovery option through mutual-aid engagement and recovery communities.

Despite time constraints and recruitment issues, the pilot project has confi rmed that TSF is a cost-eff ective option for those wishing to achieve abstinence-based recovery.

WRAP Proposal Benefi ts builds on what has been achieved by the pilot project –

individuals and organisations establish sustainable and cost-eff ective abstinence-based

recovery options provide a safe recovery group for those in early recovery

involving trained volunteers contribute towards improved “joining-up” of service provision

WRAPP OUTCOMES: WHAT NEXT? WRAP?WREXHAM RECOVERY FROM ADDICTION PILOT PROJECT