Inclusive Recovery Cities Building Local Recovery Innovation and Sustainable Partnerships within the City

Inclusive Recovery Cities Building Local Recovery Innovation and Sustainable Partnerships within the City

How has your story of Inclusive Cities begun? Could you please explain the meaning and the aims of Inclusive Cities?
 As far back as our original work on recovery capital in 2010 (Best and Laudet, 2010), it was apparent that the role of community had been under-stated and that the role of social capital had not been adequately operationalised. It was clear that communities differed not only in the number and type of community resources they had, but in the accessibility of these resources to excluded and marginalised populations (which speaks to issues of inequality). On the positive side, each of us had witnesseed recovery groups and communities that made a huge difference and that offered rich resources and opportunities to people at every stage of their recovery journeys. But that was not all they did – they contributed to the wellbeing of their communities and were a real asset to those communities. So the science question was really whether we could capture what was distinctive about those communities and what were the essential elements that made some communities and cities more suited to recovery. However, there was also a vision of sharing learning and creating a contagion or cascade of the innovations and successes of those cities and bringing together that model of success to share ideas and build recovery into the fabric of caring, compassionate and connected communities.
How is stigmatization an obstacle to sustaining recovery? Could you share a case that affects you a lot?
The idea of Inclusive Cities started from the evidence to focus on the role of the community to promote and facilitate (stable) recovery. While the community could be central to recovery by building and strengthening bridges between excluded and non-excluded groups (positive community recovery capital), this community could also act as a barrier to recovery (negative community recovery capital).
Negative community recovery capital (Best & Savic, 2015) arises from the discrimination, stigmatisation and exclusion from housing, employment, treatment, recreation, active citizenship towards persons in recovery.
Several studies acknowledge the negative effects of stigma on people suffering with substance use disorders (Room, 2005). The general public holds stereotyped and negative views, considering persons who (problematically) use drugs as lacking self-discipline (Jones, Simonson & Singleton, 2010) and as ‘dirty’ (Sloan, 2012, 407). This could impact not only several life domains, such as employment, housing and social relationships but also access to treatment (Radcliffe & Stevens, 2008).
Phillips and Shaw (2013) showed that, when compared with smokers and obese people, the general public (in the US) preferred greater social distance from persons with substance use disorders. What is troubling about this study is that it would appear that social distance did not markedly diminish when those persons were described as being in recovery, suggesting that, for many people, a substance use disorder is an irreversible strain. In 2010, the UKDPC commissioned a survey of 3 000 adults living in private households across the UK (Jones, Simonson & Singleton, 2010). The findings indicated that people recognize the importance of providing support for individuals in recovery and the need for them to be part of the community. However, they do not want them as neighbours and are fearful of having treatment and support services in their neighbourhoods.
Equally worrying are the findings of a follow-up study conducted in the UK (Cano et al, 2019) with a group of trainee health and criminal justice professionals, indicating the same issues persisted. Thus, not only is there limited openness to recovery among members of the general public, that scepticism persists among professionals as well. This evidences two sets of barriers that people in recovery must overcome - the perception that substance use disorders are a lifetime stain in the general public, and the resulting scepticism about meaningful change in professionals who are tasked with supporting their recovery pathways.
The fear among members in our community is mostly not based on personal experiences since less than half of the respondents reported knowing someone with a history of substance use disorders in the Cano et al study. Less negative attitudes have been found among those people who currently, or in the past, had lived, worked or been friends with someone with a history of substance use disorders, compared to those who did not. This indicates that knowledge and contact is generally associated with lower levels of stigmatising behaviours and attitudes. Therefore, making recovery visible and discussable is key in an Inclusive City.
 A society that discriminates, stigmatizes and excludes, imposes negative consequences for sustaining the recovery process of her citizens. Where structural and attitudinal barriers persist, the pathway to recovery might be harder to travers and might pose significant threats to long-term recovery. Addressing structural barriers (as well as personal exclusions and stigmatisations) are essential to maximise the likelihood of long-term recovery.
 
In how many countries and cities are you actively running this project? Can you give examples of good practice (with pictures)?

1. In the UK, we started with Doncaster where there was a visible champion in Stuart Green, a very progressive treatment service in Aspire, a supportive strategic leader in the Director of Public Health and a hugely innovative annual event in the form of the Recovery Games. We have continued to build on that work but now we have another city with incredible innovation in Middlesbrough, where we also have an incredibly innovative model in the form of a city-funded initiative called Building Recovery In Middlesbrough.

 
From a research point of view, our first aim here is around developing some common metrics for assessing the effectiveness of recovery events (which we are referring to as the REC-CAP Event Evaluator), as well as assessing some of the incredible initiatives that BRIM engages in including:

• A Recovery Ambassador scheme which promotes, and champions lived experience

• A recovery cafe and restaurant called Fork in the Road, where a number of Sober Social events are hosted.

• A recovery coaching scheme based in a recovery support hub called Bedford House

• The Fork Academy which provides training and experience in the catering industry

• Recovery-oriented occupational health support to the largest employer in the region, PD Ports

• An online coffee business, and a coffee bike service where Ambassadors will take the coffee bike out into the community and give people free coffee in return for chatting to them about recovery

• A collegiate recovery programme that operates in two local universities

  • Sunderland University and Teesside University

• A photovoice project that is linked to creative writing and evidencing innovation in Recovery Connections

• A new Recovery Ally scheme that is committed to generating community support and engagement for the recovery activities across the town and region

 
Recovery Connections was also a founding member of the College of Lived Experience Recovery Organisations in the UK – and has been active in championing, through this movement, evidence, innovation and quality standards for recovery communities.

2. In the Balkans, within the on-going regional Balkan project called “Choose Recovery”, a partnership among 3 recovery organisations Celebrate Recovery (Bosnia), Izlazak (Serbia) i Preporod (Montenegro) and the World Federation Against Drugs, we aimed to broaden the efforts to address stigmatization and exclusion of people affected by drug addiction using the Inclusive- Recovery Cities model. Partners have been doing amazing and unique initiatives that created a foundation for this model to be built on, such as:

   • Recovery month celebrations campaigns to mark the World Drug Day,

   • Workshops in schools,

   • Group work with women, homeless people and youth

   • Helplines and websites in each country

   • Outreach events in the local community

   • Furniture charity shop that employs people in recovery

   • Christmas in the city for homeless and vulnerable people

   • A photovoice project to make recovery visible using photos, and many more

 
We established Multidisciplinary teams-MDTs in 14 cities in Bosnia, Serbia and Montenegro over the past three years. There are many inspiring initiatives that the multidisciplinary teams have done to bridge thegaps in the system and make the services more available accessible and free for people seeking recovery. For example a great coordinated initiative in one of the cities in Serbia (Backa Palanka):

• The social and welfare services provide monthly support to people in rehab,

• Local municipality secures a car and a driver for anyone going to a tc or weekly peer support meetings in the nearby city and needing travel support,

• Health services have ensured that a person in recovery needing appointments with a doctor has a priority

• A team member from the court has also supported people in prison to go to the tc and has worked with them for the charges to be dropped so that a person can start rehabilitation immediately.

 
This work and the project has been promoted widely across the region and at the national, local and UN levels and the most beneficial was involvement of Serbian National Drugs Office which joined the partners to drive this process in Serbia. Although we are only at the start of the process, we are delighted by the level of engagement and support in some areas, and this establishes a clear need for this model to be replicated widely and optimism that we will have a mandate for future plans to develop recovery pathways across the Balkans.
 
Based on the available research and expertise, the city of Ghent (Belgium) has included “Inclusive cities” in its local drug policy plan (2020-2025). The city has identified the ambition to become an “Inclusive City” for people in recovery from addiction.
 
The first step was to install a Ghent Inclusive City Council. This core group is led by two people from the city (Filip De Sager, the local drug coordinator and his colleague working in the area of prevention, Diete Glas) and someone from academia (prof. Charlotte Colman, Ghent University). This core group has drafted a tailormade mission, vision and activities for Ghent in order to transform to an Inclusive City. The Inclusive City Council works closely together with, amongst others, people from practice (prevention, treatment, welfare), private organisations, public organisations and people in recovery. Based on that mission and vision, activities have been developed to make recovery visible in Ghent and to celebrate it.
 
On December 2, 2022 we organised our kick off event in Ghent (more info could be found here: https://www.inclusivecities.info/post/ ghent-the-first-belgian-inclusive-recovery-city)
 
This event brought together a diverse audience of practitioners, policy makers, people in recovery and their family members. It focused on visibility, connectedness and sharing knowledge about recovery. This project “Ghent as an inclusive city” aims to implement a sustainable future for people in recovery. This event was the kick-off of our 6-monthly activities that will be organised in the city of Ghent. The next event, in March 2023, will focus on access to employment, namely “Jobdating for people in recovery and employers”. After all, we know from research that employment is crucial to start and persist recovery, but unfortunately people in recovery and employers often do not know each other. Through a career dating event, we aim to match people in recovery and employers. The last event of 2023 (December 2023), will focus on recovery through sports.
 
What is the most challenging part of applying this project in other cultures and societies?
 
While recovery has been well established in the UK and US, in the Balkan societies recovery is not visible and there is a little data available about the lives of people in recovery and the barriers they face. And while the recovery movement has created a hope-based model for improving outcomes for clients, there has been less emphasis on the implications for staff and volunteers in addiction, recovery, and other services. The model of Inclusive Recovery Cities aims to create sustainable connections and networks in each city and benefits individuals with addiction problems by creating pathways to hope and reintegration for affected people as well as for staff and duty-bearers. Apart from covid pandemic that overlapped with the project, one the most challenging part of applying this model in the Balkans was addressing structural barriers and stigmatization, as well as engaging key actors from the communities in the process (including the city councils, public, private and civil society organizations, addiction professionals and those from mental health, criminal justice, primary care and education and training). While each country and each city has been different and has its own challenges, high level of stigma among the public and professionals towards people who use drugs and people in recovery aggravates already unfavourable socioeconomic situation, stops people to seek help and to be proud of their recovery. There was a lack of involvement and interest regarding support for the MDTs from key actors in some parts of Bosnia. Additionally, some team members from the MDTs still do not recognise people with lived experience as equal experts which made the collaboration especially challenging in rural areas. There are greater challenges around this in spite of these recovery organisations being at the heart of a social process based in local communities through championing recovery and creating coalitions that support and engage people in need before and post treatment and rehabilitation. It is not enough to make treatment better, but more efforts to address stigma and to celebrate recovery are essential to maximize the chances for stable recovery and grater inclusion of people. In spite of the variety of challenges, methods and activities in 14 cities, the evaluation has been remarkable in every Recovery City, and has shown the commitment and desire to continue further work of the MDTs towards building inclusive recovery community.
 
We see recovery is significantly more difficult in females than males because of stigma.   How do you think we can overcome gender problems in recovery?
 
In our work on Life In Recovery (written up in Andersson et al, 2020), we found that there are different barriers to recovery for women that often revolve around parenting and challenges with primary relationships with male substance users. There is also ofter untreated psychological health and trauma-related problems. This is often compounded by societal responses to female drug use.
 
Nonetheless, the Life in Recovery work in the UK also demonstrated that women typically have shorter substance using careers and that they will recover more effectively through active community engagement. There is now clear evidence that men and women can and will recover, on the whole, but that the pathways are different. So the first thing is not to generalise from male evidence and service to women, and also to focus on the needs of women collectively. Their active engagement in community activities is an important part of this process of challenging exlusion and stigma, and the overall aims of the recovery movement – to be active and participating citizens and to actively promote community growth and wellbeing should reduce stigma for all people in recovery and reduce barriers to recovery and residual exclusion.
 
** This interview published at the International Green Crescent Journal in 2022. https://www.yesilay.org.tr/assets/international_green_crescent_journal/2022/english/index.html#page=29 (Page 29-33)