Recovery From Addiction: Bridging the Gap Between Policy and Practice Conference Report


Conference – University of Chester April 28th-29th 2014

Recovery has become central to the addictions treatment policy agenda, but the nature of recovery and means of achieving it are subject to vigorous debate. This event provided a forum for policy makers, commissioners and practitioners, together with representatives from mutual aid groups and the wider recovery movement. It aimed to raise awareness of the diversity of the recovery landscape and to build consensus towards more cohesive policy implementation.


Dr David Best (Associate Professor Monash University & Turning Point Alcohol and Drug Centre, Australia), Tony Bullock (Commissioning lead for alcohol, drugs, smoking and mental well-being, Public Health Staffordshire Staffordshire County Council), Dr Ed Day (Senior Clinical Lecturer in Addiction Psychiatry, National Addiction Centre, Institute of Psychiatry, London & Consultant in Addiction Psychiatry, Birmingham & Solihull Mental Health NHS Foundation Trust), Steve Dixon (Chief Executive, Changes UK), Dr Wendy Dossett (Senior Lecturer & Co-Director of CSARS Group, University of Chester), Mark Gilman (Strategic Recovery Lead, Public Health England), Peter H (NA Public Information Committee), Geoff H (AA Trustee for Health Liaison), Megan Jones (Senior Programme Manager Alcohol & Drugs, Commissioning and Clinical Practice Development Team, Public Health England), Chris Lee (Senior Public Health Coordinator – Substance Misuse, Lancashire County Council), Tim Leighton  (Director of Professional Education and Research, Action on Addiction), Dr Luke Mitcheson (Consultant Clinical Psychologist, Head of Addictions Psychology and Lead Psychologist for Lambeth Addictions South London and Maudsley NHS Foundation Trust & Consultant Clinical Psychologist at PHE), Richard Phillips (Director, SMART Recovery UK), Caroline Phipps (Chair, Welsh Government’s Recovery Sub Group), Jon Roberts (Recovery Practitioner & Counsellor, Leicester)Alistair Sinclair (Director, UK Recovery Federation), Mario Sobczak (Kingston RISE)Prof John Stoner (Co-Director, CSARS Group, University of Chester), Dr Samantha Weston (Lecturer in Criminology, University of Keele).

Programme Abstracts Contributors Public Lecture Poster


New directions in policy for the treatment of substance misuse have emerged in recent months both from Welsh Government and from Public Health England.  These are set out in the Substance Misuse Treatment Framework (SMTF) Recovery Oriented Integrated Systems of Care (commonly known as the Welsh ‘Recovery Framework’) and in PHE’s new Guidance document on Facilitating Access to Mutual Aid. These follow on from previous policy documents focussing on recovery in Scotland – Road to Recovery (2008) and England – Putting Full Recovery First (2012).

With professional treatment services reduced through public sector austerity measures, attention has turned to the potential role for ‘Mutual Aid’ in supporting people seeking to address substance misuse issues.  Organisations such as Alcoholics Anonymous, Narcotics Anonymous have existed in communities for decades, and have more recently been joined by SMART, which addresses a range of addictive behaviours.  However, these independent, non-professional, not-for-profit, grassroots groups are now appearing on the radar of governmental policy makers, because of their potential to make a significant contribution to the delivery of recovery-oriented systems of care.

The two-day Chester Conference Recovery from Addiction: Bridging the Gap between Policy and Practice took the new policy direction as its theme, and brought together policy makers, addictions researchers, recovery movement activists and mutual aid fellowship representatives to consider the challenges of this new environment for all the stakeholders involved.  As well as introducing the significant new documents, the conference considered various key questions. Some of these emerged in formal papers, and others were addressed in focused workshops in which Professionals, Mutual Aid groups and members of the wider Recovery Movement reflected on their role in the new landscape and considered projects and plans for the way forward. Scroll down for detailed reports on the workshop outputs. Click here for PowerPoints videos of the presentations.

What is recovery and what mediates it?

Key note speaker Dr David Best  sought to question some of the easy definitions of recovery that appear in policy documents, and to encourage delegates to think of it in very broad and inclusive terms. In his keynote evening lecture ‘What Makes People Recover?’ he described recovery as ‘learned behaviour.’ He affirmed the thrust of the papers of earlier speakers such as Mark Gilman and Tim Leighton, that whilst recovery is individual and personal, it usually happens in communities. Such communities may be recovery-oriented, but any kind of community which offers bridging social capital is beneficial.  Tim Leighton described recovery as happening ‘in the spaces between people,’ and highlighted the crucial (yet not well understood) role of the emotions in recovery.  David Best and several others argued for a strengths-based approach to building recovery capital, and to value the key ‘shifts’ which evidence recovery – from ‘using social networks’ to ‘abstinent social networks,’ from troubled identities to helping identities, in other words from hedonic to eudaemonic lifestyles.  Best also noted that on some measures of quality of life, people with five years or more recovery score higher than the population average.

How are recovery-oriented systems of care best delivered?

Dr Samantha Weston  explored the impact of ambiguity in government policy on delivery, and other speakers highlighted the impact on outcomes of low professional optimism, and the need for a Fifth Wave of Public Health. The value of peer-to-peer support was a recurring theme throughout the conference, and delegates learned about numerous projects which harness that power. The UK Recovery Federation is a community-building organisation for individuals and groups who sign up to broad recovery principles, and is, amongst other projects, focused on bringing communities together to celebrate Recovery Month.   Delegates heard about the film Dear Albert, created by Nick Hamer about the journey of Jon Roberts, whose street name was Albert.  Delegates heard about Changes UKa Birmingham-based social enterprise based on the Community Interest Company model that supports people on their recovery journey towards independence. They also heard about the work of Kingston RISE, a community and social enterprise group which acknowledges the difficulties of building meaningful communities in fragmented modernity and seeks to develop the community links and partnerships to ameliorate this. The role of Mutual Aid was also explored. Dr Ed Day explained that meta-analysis of hundreds of studies showed that engagement with Alcoholics Anonymous delivered consistent, moderate, beneficial effect, and had numerous advantages in providing cost-neutral  and paper-work-free support at high-risk times, for as long as needed. They provide recovery-oriented positive social networks, which are protected for the newcomer by the commitment to anonymity.

What are the challenges and obstacles for professionals linking to Mutual Aid groups?

Dr Ed Day reviewed some of the problems reported by professionals seen as obstacles to assertive linkage.  There is a widespread perception that the ‘anonymous’ groups are ‘religious’ and therefore inappropriate to most clients.  Dr Wendy Dossett’s research, the Higher Power Project  may help to correct that perception by describing the diversity of the language used by contemporary members.  Some professionals see the group setting as ‘intimidating’ and therefore not suitable for their clients. Some professionals say their clients reject the perception that they must see themselves as addicts or alcoholics ‘for life’, wishing rather to ‘move on.’  Professionals were also concerned that Mutual Aid could not provide clinical support (e.g. for blood-borne virus treatment and detox, mental health assessment and referral). Prof John Stoner explained in his presentation on the WRAP Project  that staff perception work had been undertaken in Wrexham which demonstrated that reservations were based on limited awareness and understanding of 12-Step programmes and groups, and that perceptions were changed by attendance at a half-day training event and attendance at an AA or NA open meeting.

The policy and organisational changes, structural and ideological obstacles, and reduction in resources facing commissioners were described. Tony Mercer highlighted the Five Ways to Well-being (Give, Be Active, Connect, Take Notice, Keep Learning) and the new PHE Toolkit, which incorporates NICE Quality Standards and Clinical Guidelines , RODT: Medications in Recovery and ACMD: Recovery Standing Committee’s 2nd report on recovery outcomes.

A ‘specialist’ and community-led strategy in Staffordshire was outlined by Tony Bullock, which embraces existing resources and contributes back to the community (ABCD – Asset Based Community Development). Chris Lee described how in Lancashire they are creating the space for recovery and developing initiatives with the Lancashire User Forum, Red Rose Recovery and the recovery community.

What challenges are likely to be faced by the Mutual Aid groups in the new policy landscape?

SMART Recovery  has a structured relationship with professionals, and can be ‘commissioned’ to provide Mutual Aid support. This process was explained in a SMART recovery presentation. The Anonymous fellowships are entirely grassroots and independent, and have no formal relationship with the professional sector. Different challenges are faced by the different types of mutual aid. However, both types are thin on the ground in some areas, especially in rural areas. Professionals wishing to encourage Mutual Aid attendance are sometimes limited by the geographical factor. Currently in the UK there are around 4,000 AA groups and 400 NA and 400 SMART groups.

A presentation from Narcotics Anonymous  explained the process of setting up a new meeting.  A presentation from Alcoholics Anonymous  explained the Traditions of AA, sometimes seen as problematic from a professional point of view. The Traditions of anonymity mean that service positions ‘rotate’. The purpose of this is so that no one individual can become associated with, (or ego-invested in) a particular role. Whilst this preserves individual recoveries, and the safety and independence of the fellowship, it makes life difficult for professionals who want to develop lasting relationships with senior representatives.  An AA presentation also tackled the issue of the aging profile of members. AA has been around for more than 70 years, so its members are aging, making it potentially less attractive to younger people. This issue is being addressed through the Young People’s Project 

The Mutual Aid groups all welcomed the new policy direction, but were keen to reflect on and improve their readiness to meet the needs of the potentially large number of “newcomers” likely to come their way as a result, and to caution against any kind of coercion.

In amongst the academic and policy discussions and debates, delegates were privileged to hear some personal stories of recovery, emerging from a range of recovery communities and activities. These stories of hope, inspiring for those seeking recovery themselves, and for those seeking to support them

Bridge Conference Presentations

If you are searching for a presentation which does not appear here, please contact the relevant speaker directly. Scroll down for link to videos.

Contributors’ biographies 2014

Name Title PowerPoint
Dr David Best What Makes People Recover?
Tony Bullock A ‘specialist’ and community-led strategy Bullock Strategy in Staffs
Dr Ed Day Twelve Step Fellowships & Programmes:  Potential Options & Barriers Day -Twelve Step Fellowships Programmes 
Steve Dixon Changes UK Dixon Changes UK
Dr Wendy Dossett How Religious are AA/NA? Dossett How religious AA-NA
Mark Gilman Desistance, Recovery & Austerity Gilman Desistance, recovery Austerity 
Peter H How addicts stay clean through Narcotics Anonymous
Geoff H An AA Board Member’s Perspective Geoff AA board members perspective
Geoff H The potential, constraints, availability and response of Alcoholics Anonymous Geoff Terms of Engagement.
Megan Jones & Dr Luke Mitcheson Helping clients to engage with mutual aid Jones & Mitcheson PHE Mutual-Aid Engagement
Chris Lee Creating the space for the development of sustainable recovery in Lancashire Lee Commissioning the space for recovery
Tim Leighton Exit From Treatment – Strategies Leighton Exit from treatment – strategies.
Tony Mercer Commissioning Mutual Aid Facilitation – obstacles and opportunities Mercer Mutual Aid Facilitation
Richard Phillips Evidence for Mutual Aid in the UK context, SMART Recovery and innovations in Partnership Phillips SMART Recovery
Caroline Phipps Recovery in Wales – Theory to Practice Phipps Recovery Framework Wales
Jon Roberts Working out what’s best for you: a new approach to facilitating into mutual aid. Roberts Leicester Recovery Partnerships
Alistair Sinclair Recovery Contagion Sinclair Recovery ContagionSinclair Engagement with the Wider Recovery Movement
Mario Sobczak Recovery through Community Engagement
Prof John Stoner Preliminary Results from the Wrexham Recovery from Addiction Pilot Project (WRAPP) Stoner WRAPP Preliminary Results
Dr Samantha Weston Drug Policy to Practice and the Origins of Conflict Weston From policy to practice and the origins of conflict
Phil W The Young People’s Project in AA YP Project Phil W.

Presentation Videos

Reports on the workshop outputs

Workshops: The rationale

The objective of the workshop was to produce outputs and ideas that will help to support the recovery movement as it goes forward in the UK from the perspective of Professionals, Mutual Aid Groups and the Wider Recovery Movement. Delegates joined which ever group best reflected their interest and expertise.

These three groups were asked to provide two outputs from their discussions:

  1. An assessment of the strengths and weaknesses of their sector in relation to the engagement of professionals with mutual aid groups and recovery communities.
  2. A list of priority actions or projects that will assist in taking the process forward.

Mutual Aid Workshop Report


The focus of discussion for the Mutual Aid group was on the benefits Mutual Aid brings to the recovery scene. Mutual Aid is free, it works, it has a long history and set of traditions to protect it. It is inclusive, it has a wide geographical presence; it is international. It is well known and recognised, with a good evidence-base.  It provides positive social networks. It is independent from any professional group, pecuniary interest or outside agenda. Mutual Aid offers fun and laughter, healing and catharsis. It is structured yet anarchical, with every group being independent.  It is ‘already there,’ naturally, in the community, and in theory has the capacity to expand infinitely. However, Mutual Aid groups do face challenges in the current environment. There is widespread public and professional misunderstanding of the spirituality found in the anonymous fellowships, though it was not completely unanimously felt that this was a problem for the anonymous fellowships. Some members of this workshop felt there was something inadequate about with the image and ‘branding’ of Mutual Aid.   Although Mutual Aid has a known evidence base, the fellowships do not use this to promote themselves, because that would be at odds with the Tradition (11) of favouring ‘attraction rather than promotion.’  Most Mutual Aid groups are dominated by white males with an older age profile. This lack of diversity makes them inevitably less attractive to some sections of the population.  There are some areas in the UK that are not well served by meetings, especially of the smaller fellowships such as NA; and SMART, which, though growing, is doing so from a small base.  Workshop members saw the new policy environment as very beneficial for enabling Mutual Aid to be of use to ‘harder to reach’ populations who may not otherwise access meetings. This would be a chance to enhance fulfilment of ‘primary purpose.’ They also felt it would have an overall beneficial effect on the service structure as there would be more people available to take service positions and thereby deepen their recovery, whilst supporting others.  The workshop group welcomed the interested shown by policy makers and saw this as an opportunity to address the issues of stigma around recovery in Mutual Aid. Whilst the anonymous fellowships do not affiliate with organisations, nor change what they do under pressure from the outside, they do view this as a chance to communicate their message more clearly and inclusively. However, they also noted that changing group dynamics resulting from newcomers with a range of complex needs may present challenges to a minority of conservative fellowship members.  The members of the workshop were very clear that any type of coercive referral would be out of line with the Traditions of the anonymous fellowships, and would be ineffective, so whilst they welcomed ‘Facilitated Access’ they would cease to do so were it to become directive or coercive, and were aware of a possible systemic risk of this.

Two possible projects were identified for consideration:

  1. The development of meetings in areas of low Mutual Aid presence.

The possibility of using the service structure of fellowships to help identify appropriate areas was considered. The group wondered whether there might be a role for service positions for a ‘growth officer’ or intergroup/region ‘outreach committees.’ Both the anonymous fellowship reps and the SMART reps were enthusiastic about helping to effect a culture change towards being more proactive in this respect. The question of social media was also one that fellowships were prepared to explore.  It was proposed that Convention Workshops could be used to get the information about the new policy environment out to fellowship members, and to assist fellowship members in thinking about how this will impact them, and what they might do about it pro-actively.

  1. Produce some literature to clarify the religious/spiritual aspects of the anonymous fellowships and to communicate inclusiveness.

The Conference (i.e. the members of)  AA have mandated the Literature Committee of the General Service Board to produce a leaflet based on what was is already published designed to clarify this issue. There was a very helpful offer from a professional present in the workshop to read and comment in advance of publication, and the workshop considered consultation to be worthwhile.

It was also noted that FAMA (Facilitated Access to Mutual Aid) had a crucial role to play in clarifying the inclusiveness of AA/NA Spirituality, and fellowship members could make a contribution to this.

Reports on the workshop outputs

Workshops: The rationale

The objective of the workshop was to produce outputs and ideas that will help to support the recovery movement as it goes forward in the UK from the perspective of Professionals, Mutual Aid Groups and the Wider Recovery Movement. Delegates joined which ever group best reflected their interest and expertise.

These three groups were asked to provide two outputs from their discussions:

  1. An assessment of the strengths and weaknesses of their sector in relation to the engagement of professionals with mutual aid groups and recovery communities.
  2. A list of priority actions or projects that will assist in taking the process forward.

Professionals Workshop

Workshop Report: Professionals

This group comprised principally professionals from a wide range substance-misuse services, but there were also representatives from mutual-aid groups and the wider recovery movement.

Before undertaking the SWOT analysis and identifying priority actions, there was a general discussion on the culture change required for the new recovery policy of engagement with mutual-aid and recovery communities to be fully and effectively implemented. Several professionals expressed their feelings of vulnerability around the policy change, questioning what their roles would be, if any.  Concerns were expressed regarding how changes could be implemented in the context of the current risk-averse ‘CQC’ regime and whether professionals could rely upon mutual-aid and recovery groups to safely accommodate a large influx of new members.

SWOT Analysis:


Clinical Interventions will continue to be required by many in addition to referral to recovery groups and these will need to be provided by professionals.

Liaison with other professionals (e.g. probation, social services) will still be necessary to address individuals’ issues that will not be resolved through mutual aid/recovery groups.

Long-term ‘safety net’ provision will be required – some individuals are not suited to participation in recovery through groups and will drop out of programmes temporarily or permanently.

Supervision and Monitoring of clients can only be undertaken by professional services – recovery groups (e.g. the Anonymous Fellowships) are unable or unwilling to do this.


Lack of awareness of Mutual Aid / Social ‘model’ –studies have shown that many professionals have had no direct experience and a limited understanding of recovery groups and programmes.

‘Believe our own hype’ – “professional preciousness” and belief that professionals themselves offer the best solutions.

Not involving service users – the level and means of current engagement between professionals and mutual-aid/recovery groups is patchy. There is widespread concern expressed by service users that they are not involved enough and that there is a culture of “we know what’s best (for you)” . Improved awareness, understanding and local liaison between professionals and recovery groups will be required in order to fully implement the new policy of engagement.


Humility –working with others on equal terms, being receptive to others’ views and experience.

Choice – extending the menu of options available to service users, including abstinence-based and other recovery solutions.

Working with commissioners – contracts that incorporate the provision of mutual-aid and recovery community options need to be developed.


Uncertainty – the turbulent environment resulting from the proposed reduction in resources and organisational change can mitigate the development of new working relationships.

No code of ethics – Generic drug workers, unlike nurses or social workers, have no cod eof professional standards that can be used to promote best practice. A code of ethics needs to be developed.

Job security – individuals and organisations feel threatened by the current organisational changes and this can result in resistance to embracing the policy of engagement with the recovery community.

Sector-wide politics – the resistance to change of all vested interests will have to be challenged and overcome.


Whilst the members of this workshop expressed feelings of optimism and positivity, there was also some scepticism and frustration, and questions about where the professional sector fits in.


Two firm proposals were suggested by the group:

1)      Use FAMA to ensure staff attend mutual aid groups

  • Go to meetings
  • Enthusiastically link clients to groups
  • Fellowship presentations to professionals
  • Applying FAMA principles to training staff
  • Find out what meetings are available and establish contacts

2)      Ask for help from the recovery community and service users to influence the professional service ‘quality agenda’

  • CQC requirements are perceived as onerous, risk-averse and therefore a barrier to implementing the changes required by encouraging engagement with Third Sector groups.
  • Red Tape Challenge – this might be met by expanding the CQC’s policy making body to include representatives from mutual-aid and recovery organisations.

Reports on the workshop outputs

Workshops: The rationale

The objective of the workshop was to produce outputs and ideas that will help to support the recovery movement as it goes forward in the UK from the perspective of Professionals, Mutual Aid Groups and the Wider Recovery Movement. Delegates joined which ever group best reflected their interest and expertise.

These three groups were asked to provide two outputs from their discussions:

  1. An assessment of the strengths and weaknesses of their sector in relation to the engagement of professionals with mutual aid groups and recovery communities.
  2. A list of priority actions or projects that will assist in taking the process forward.

Wider Recovery Movement Workshop


As a workshop on the wider recovery movement, chaired by a professional (Dr David Best), the focus was mainly on ‘how can the wider recovery movement and the professionals work together and complement each other to enhance the goals of ‘recovery’ and its growth in the UK?’


Experience – while some delegates were not keen on the phrase ‘expert patient’, it was generally agreed that the first hand experiences of the wider recovery movement were without parallel as a tool.

‘Infiltration’ – sounds subversive, but in the context of the discussion meant that recovery oriented services were no longer the preserve of the ‘professionals’ but that the recovery movement were increasingly finding genuine work settings and a clear place for the recovery community in the wider treatment system. In some areas, this reality was embraced by the professionals.

Visibility through Unity – this was discussed as a challenge to itself by the wider recovery community to consider that ‘unity’ is how strength is demonstrated. The sense of the group was that this is real and happening now in the UK.

Pro-active, flexible partnerships – this was seen as a challenge to both professional and the wider recovery movement. The need for cooperation between the professionals and the recovery community is paramount to the success of both and both have unique skills and attributes that complement each other.

Passion, compassion, love – these humanistic qualities of the recovery movement were considered as genuine and appealing assets from the perspective of professionals and critical to supporting the initiation and continuity of recovery.

Non-judgemental – the wider recovery community is less likely to ‘stereotype’, ‘classify’ or ‘stigmatise’ those engaging with professional services. A genuine empathy was available.

Recovery Communities –the people that populate the recovery communities can act as the gateway to recovery for those who are trying to get in from the fringes.


5 ways of wellbeing – the UKRF have adopted this model as one of its guiding principles and is a good set of basic guiding principles for both individuals starting their recovery journeys and for recovery groups to work to.

Reduce Stigma – stigma was almost universally considered to be a major problem. The difference between public perceptions of addiction and recovery in the US and the UK was noted and the group discussed how we can change negative stereotyping into the welcome on to the professional platform of ‘recovering professionals’.

Genuine partnerships WITH professionals – ultimately, if achieved, this would be an incredibly powerful tool for making progress in areas where previously there had been a loss of direction.

Give opportunities and responsibilities –  there has to be real and structured incentives. This means offering professional roles and responsibilities to members of the recovery community who are contributing. People develop self-esteem and efficacy by being given and taking responsibility

Learn mutual respect and roles – recognition of limitations and capabilities. These can be explored through genuine partnerships. Knowing the difference between passion and expertise and marrying the objective skills of the professionals with the personal commitment, sharing and passion of people in recovery.

Turn professional fear into professional love – Professional fear was acknowledged as a barrier between the professionals, those engaging with services and those seeking to help in those communities. A very emotionally charged working environment has become unloving in some areas and the result has been polarising. This must be turned around.


Learning/communication – members of the wider recovery community need the necessary training and skills to be effective in their roles in the professional arena. Steve Dixon from Changes talked about the ‘Recovery Academy’ in Birmingham as a model where those who wanted to work in field of recovery are given opportunity to train for NVQ level 3 Health and Social Care as standard. This helps to ensure they are taught how to communicate in professional circles.

Maintenance culture -there are areas of health and social care and ‘treatment’ services where the ‘maintenance culture’ is still embedded. There is recognition of the need for the service but whether or not as an off the shelf solution is another question. Engaging the maintenance population in recovery is a major challenge – for staff and clients.


Is PHE focus too narrow – Does mutual aid hold all the potential solutions that PHE is hoping for? Are they looking at the right areas?

Professionals fears about their role –Are ‘recovering workers’ going to be cheaper, more efficient, more passionate and more effective? Don’t forget the families – families may offer crucial support for recovery, or alternatively be part of the problem, feeding the cycle of addiction.

The workshop developed a Seven Point Plan to address these problems.

  1. HUMANISING EDUCATION – which involves joint working with mental health and alcohol and other drug workers as well as showing professionals the power of love and sharing – and how the recovery community can teach and support this.
  2. COMMITMENTS TO THE LIVED COMMUNITY – which involves human voices and coalitions that are embedded in a range of community activities
  3. POLITICAL VOICE which includes pressure groups and community voices – recovery groups as a power for change
  4. JOB-SWAPS It was acknowledged that those working in the field as peers in recovery may not fully understand the challenges of professionals’ roles. ‘Job swaps’ offer a way of achieving the improved awareness.
  5. INFLUENCE PUBLIC POLICY and petition for increased recognition and respect for the role of recovery
  6. CHANGE CULTURE – using the tools of co-production to challenge discrimination and stigma in the local community
  7. CHANGE PUBLIC OPINION to create opportunities for access and engagement

This plan included some weighty aspirations but these reflected the sense of duty and the passion for the wider recovery movement as it contributes to a new working culture in partnership with professionals. The first 4 are functions for the wider recovery community to fulfil and in doing so help to action points 5-7 from the bottom up. The overriding aspiration is that professionals will be attracted to engaging with the recovery movement.