Mark Gilman: 12-step recovery programmes are best for addicts | James Legge

England's addiction recovery champion wants councils to make greater use of mutual aid groups such as Alcoholics Anonymous

Mark Gilman is a man with a mission. In his role as England's addiction recovery champion, it's his aim for the country's addiction treatment services to tap into what he sees as an underused resource: mutual aid groups, such as Alcoholics Anonymous and Narcotics Anonymous.

These groups, known as fellowships, are based on the premise that there are 12 steps to recovering from addiction, from the first, of admitting powerlessness in the face of addiction, to taking stock of personal failings and past wrongs and handing over life's decisions to an unspecified "power greater than ourselves". The 12th and final step comes – after a spiritual awakening – with carrying the fellowship's message to others struggling with addiction. And now Gilman is touring the country trying to cajole local health commissioners and providers into referring more service users to these groups.

It is a controversial move, and Gilman himself admits the fellowships are "something that we, as treatment professionals, have tended to see as rather unscientific, folky, kind of interesting-but-quirky". Doctors and commissioners tend to be sceptical because of the lack of clinical evidence that these groups work, and their religious o ertones, which jar with more secular approaches to treatment. Gilman admits he has faced resistance from some commissioners.

Strong network
However, he claims that a strong network of friends is crucial to maintaining recovery, and points to 2007 guidance from the National Institute for Health and Clinical Excellence, which advises that all addiction treatment "should routinely provide people who misuse drugs with information about self-help groups. These groups should normally be based on 12-step principles, for example, Narcotics Anonymous and Cocaine Anonymous" – advice which, Gilman says, has "been roundly ignored".

His views dovetail with the government's desire to make addiction treatment more focused on recovery. "Suddenly, now, the focus on the importance of friends casts [12-step fellowships] in a brand new light, whereby we are encouraged – and we are encouraging others – to re-evaluate things like AA," he says.

He told a global addiction conference in May about his new enthusiasm for 12-step mutual aid groups, saying afterwards: "I bet those doctors wondered what the hell I was talking about: 'What, Public Health England thinks the answer is to go to meetings which have been going since 1935? That are free? Duh!' But actually, yeah."

And, he says, during a time of straitened local authority budgets, it helps that support from mutual aid groups "is available 24 hours a day, 365 days a year, and is completely free of charge".

Growing up above his parents' newsagent's in Bury, Greater Manchester, in what he calls a "blue-collar, working-class" area, Gilman left school at 16 and spent a decade travelling the world. At 25, he went to study at Bradford University, then did research into the burgeoning use of brown powder heroin among youths in the north of England, mainly in Merseyside and Greater Manchester, inner-city areas where he says "high unemployment, poverty, deprivation and criminal activity were normal". He learned about the relationship between drug addiction and time management, and the vacuum that the mass unemployment of the 1980s had left in the daily lives of many people. "Maintaining a heroin habit on the dole was a full-time job," Gilman says. "Get up, go out 'grafting', get something to sell, sell it, get the cash, find the dealer, find somewhere safe to use it – enjoy the hit for an hour or so, max, and then do it all over again.

"Just as heroin addiction, out of treatment, filled the time vacuum created by unemployment, so methadone, booze, benzos, benefits and Jeremy Kyle fill the current time vacuum of those in treatment."

During his time at the National Treatment Agency, Gilman was dismayed by the number of patients still in the treatment system after years of harm reduction measures. He says for too long the government's focus was to keep people "alive and out of prison". "The thinking was that if you're in treatment then you're alive – which is fantastic and crucial – [you] aren't in prison, and are free of HIV. All three points are crucial. But from a public health perspective, if those people are alone, they're in a very dark place, they're in a very recovery-unfriendly place."

It was in the north-west that Gilman first became interested in what mutual aid groups could achieve. Citing a visit to an AA meeting in Rochdale in 2006, he says: "I've seen miracles in that place. [There was] a woman I'd convinced myself was dead, because the last time I saw her, at Christmas, 1980-something, she was being carted into an ambulance having had a massive overdose, injecting heroin into her groin. And then she's there, brand new. Any doubts I had then were gone. If you can get where she is from where she was, well anybody can."

How does he respond to service-users who are sceptical about what 12-step groups can do? "I tell them: 'You say you're going to do it on your own. But on your own, you've always ended up back here asking for your script back, or in Strangeways or Walton [prison]. You don't do great on your own, so let's just try you with somebody else.'"

Gilman has his work cut out to drastically improve referrals and use of these 12-step groups. Treatment for addiction is now the responsibility of 152 local authorities, which have taken over the ringfenced public health budget, worth £5.45bn over two years. As well as getting commissioners and providers on board, Gilman has to persuade the national leaders of the 12-step fellowships and secular alternatives to make closer contact with treatment services in their areas – there are not always links between commissioners and mutual aid groups. He has also held meetings with organisers of the 12-step groups. "They have been a bit sceptical," he says, "but [his approach] went down incredibly well. I say all I'm doing is trying to organise the 152 local authority areas and all the treatment services to get as many people to your door as possible. That's got to be a good thing because you're forever telling us that your primary purpose is to carry the message to the addicts and alcoholics who are suffering; the lifeblood of the 12-step fellowships are newcomers – we'll give you a whole raft of newcomers."

A spokesman for NA says: "We are delighted that Mark is encouraging recovery as our meetings are open to any addict, however they find us." But he warns that NA will not change its way of working simply to garner more attendees at its meetings. "We go to great lengths to impress upon Public Health England (PHE) that our relationship with them will always be guided by our traditions and principles," he says.

Gilman says he wants all addicts to be able to attend mutual aid meetings. "We've got something like 300,000 heroin and crack cocaine users in England. Over time we've probably had the vast majority in treatment, around 200,000. I'd like every one of them to have some exposure to [12-step fellowships]."

For him, these offer not just a lifeline but the prospect of lasting relationships. "In PHE, three things we focus on in particular as essential to people's recovery are jobs, homes and friends. In Burnley, you can't get a job, but you can have the street. In Borehamwood, you can have a job, but you can't get a broom cupboard. [In] Burnley or Borehamwood, you can have friends tonight. And all you've got to do is to suspend your suspicion about what on earth they're about."

Whether local authorities will suspend their suspicion remains to be seen.

Curriculum vitae

Age 56.

Family Married with two teenage daughters.

Home Bury, Greater Manchester.

Education Derby high school, Bury; BA Hons in organisation studies, Bradford College; MA in crime, deviance and social policy, Edge Hill University.

Career April 2013 to date: strategic recovery lead, Public Health England; 2011-2013: national recovery champion, National Treatment Agency; 2005-11: north-west regional manager, National Treatment Agency; 2001-05: north-east regional manager, National Treatment Agency; 1999-2001: drug prevention advisory service, Home Office; 1993-99: director of research, The Lifeline Project, Manchester; 1987-93: prevention manager, North-West Regional Drug Training Unit, Manchester; 1985-87: manager of Trafford community drug team, Sale, Greater Manchester.

Public life Board member, The Recovery Academy.

Interests Manchester United football club and fly-fishing.

• This article was amended on 14 June 2013 to remove the attribution of the quote from Narcotics Anonymous

Contributor

James Legge

The GuardianTramp

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