Presentation on theme: "The language of recovery Recovery Health Summit Winnsboro, South Carolina September 30, 2014 Ed Johnson, M.Ed., MAC, LPC The Carolinas and Kentucky."— Presentation transcript:
1 The language of recovery Recovery Health Summit Winnsboro, South Carolina September 30, 2014 Ed Johnson, M.Ed., MAC, LPC The Carolinas and Kentucky Program Manager Southeast Addiction Technology Transfer Center, HHS Region
2 Southeast Addiction Technology Transfer Center (Southeast ATTC, Region 4) Southeast ATTC is one of 10 Regional and 4 National Focus resource centers for addiction-related information funded through by the Substance Abuse and Mental Health Services Administration (SAMHSA). Southeast ATTC, located at the National Center for Primary Care at the Morehouse School of Medicine in Atlanta, serves the states of Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.
5 wordsWords are important. If you want to care for something, you call it a flower;if you want to kill something, you call it a weed.Don Coyhis
6 Language MattersLanguage is the key to changing the way people with substance use disorders see themselves and the way they are seen by others.Changing language is a way to personally and culturally close one chapter in our history and open another.Our goal today is to open a discussion about the layers of meaning that fill our personal and professional language while being respectful to all points of view.Be willing to question your beliefs and assumptions about the language we use
7 Watch your thoughts,they become wordsWatch your words,they become actions,Watch your actions,they become habitsWatch your habits,they become characterWatch your character,it becomes your destinyAnon.
11 “We know from the research that has been conducted by some of the worlds leading neuroscientists that drug addiction is not a moral failing on the part of the individual, it’s a chronic disease of the brain and it can be treated. This isn’t my opinion and is not a political statement and it really isn’t open for debate because the evidence is clear and it’s unequivocal. It’s a fact born out by decades of study and research and it’s a fact that neither the government nor the public can ignore.”Gil Kerlikowske, Director of National Drug Control Policy Betty Ford Center June 12, 2012
12 Types of Chronic Diseases HypertensionDiabetesAsthma
14 RECOVERY“Recovery is a process of change whereby individuals improve their health and wellness, to live a self- directed life, and strive to reach their full potential.”SAMHSA/CSAT 2011How is Recovery Defined? In 2005, the Center for Substance Abuse Treatment (CSAT, within the Substance Abuse and Mental Health Services Administration, SAMHSA), held the first National Summit on Recovery. The Summit was part of a process to enable a diverse group of participants to interact and engage in dialogue about recovery. This was the first time a broad-based consensus on guiding principles of recovery and elements of recovery-oriented systems of care was achieved on a national level.The synthesis of ideas and recommendations emerging from the Summit were:Definitions of Recovery and Recovery-Oriented Systems of CareGuiding Principles of Recovery and Elements of Recovery-Oriented Systems of CareRecommendations for the Treatment and Recovery FieldThese definitions and principles have evolved since that time, with the last definition of recovery released by CSAT in December 2011 (as shown on the slide). In August 2011, SAMHSA’s provided stakeholders the opportunity to comment on the working definition of recovery and related guiding principles. All ideas were given careful consideration, and suggestions were incorporated into the final definition and principles. These will be covered more in detail in Module 2.
15 Guiding Principles of Recovery Recovery is person-drivenRecovery occurs via many pathwaysRecovery is holisticRecovery is supported by peers and alliesRecovery is supported through relationships and social networksRecovery is culturally based and influencedRecovery is supported by addressing traumaRecovery involves individual, family and community strengths and responsibilitiesRecovery is based on respectRecovery emerges from hopeThe guiding principles are broad and overarching, intended to give general direction to the field as the treatment and recovery field moves toward operationalizing recovery-oriented systems of care and developing core measures and evidence-based practices. A recovery approach recognizes that there are many pathways to recovery and promotes a philosophy of individual choice. A broad array of supports are available to meet the holistic needs of the individual. Services are designed to support recovery across the lifespan, with the understanding that needs and resources shift and change with age and life-stage, as well as over the course of recovery.Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.Recovery is person-centered: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds including trauma experiences that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized. They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence is the safest approach for those with substance use disorders. Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation. The array of services and supports available should be integrated and coordinated.Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations including values, traditions, and beliefs are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.Recovery is supported by addressing trauma: The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.Reference:Hyde, P. (2001) Shaping the Future: Challenges and Opportunities (conference presentation). Washington, DC: SAMHSA.
17 The Most Respectful Way of Referring to People is as People CurrentAlternativeReasoningClients / Patients / ConsumersThe people in our programThe folks we work withThe people we serveMore inclusive, less stigmatizingAlex is an addictAlex is addicted to alcoholAlex is a person with a substance use disorderAlex is in recovery from drug addictionPut the person firstAvoid defining the person by their diseaseThe terms listed below, along with others, are often people’s ineffective attempts to reclaim some shred of power while being treated in a system that often tries to control them. The person is trying to get their needs met, or has a perception different from the staff, or has an opinion of self not shared by others. And these efforts are not effectively bringing them to the result they want.Mathew is manipulativeMathew is trying really hard to get his needs metMathew may need to work on more effective ways of getting his needs metTake the blame out of the statementRecognize that the person is trying to get a need met the best way they know howKyle is non-compliantKyle is choosing not to…Kyle would rather…Kyle is looking for other optionsDescribe what it looks like uniquely to that individual—that information is more useful than a generalizationMary is resistant to treatmentMary chooses not to…Mary prefers not to…Mary is unsure about…Avoid defining the person by the behavior.Remove the blame from the statementJennifer is in denialJennifer is ambivalent about……Jennifer hasn’t internalized the seriousness of….Jennifer doesn’t understand…………Remove the blame and the stigma from the statement
18 Current Term / PhraseAlternativeSelf Help GroupsMutual Aid GroupsSubstance Abuse / AddictionSubstance Use DisorderDrug of Choice / AbuseDrug of UseDenialDenial / AmbivalenceRelapseRecurrence/SetbackRelapse is Part of RecoveryRecurrence may occur as part of the DiseaseClean & SoberDrug Free; Free of illicit or non-prescribed medications
19 Describing a recovery oriented system of care Recovery-oriented systems of care shift the question from “How do we get the client into treatment?” to “How do we support the process of recovery within the person’s environment?” H.Westley Clark, MD, JD, CAS, FASM
20 Recovery Management (RM) is a philosophical framework for organizing addiction treatment and recovery support services across the stages of:pre-recovery identification and engagementrecovery initiation and stabilization (treatment), andlong-term recovery maintenanceWith the ultimate goal of quality of life enhancement for individuals and familiesRecovery Management is a term that is now being used to encompass how the process of “continuity of care” in addiction treatment and recovery services are organized. Recovery Management is a time-sustained, recovery focused collaboration between service consumers and traditional and non-traditional service providers toward the goal of stabilizing, and then actively managing the ebb and flow of substance use and other co-occurring disorders until full remission and recovery has been achieved, or until they can be effectively self-managed by the individual and his or her family (White, Boyle, Loveland and Corrington, nd).The Recovery Management model allows for variation and regulation of the intensity of the interventions. Not everybody needs an intervention at the same time or at the same level of intensity. Professionally-directed treatment becomes one of many possible pathways to recovery and a preferred pathway for those experiencing high severity, multiple co-occurring problems or low levels of natural support.A recovery management model involves viewing substance use as a long-term condition requiring long-term support. Recovery management models are based on the belief that full recovery is seldom achieved from a single episode of intervention or treatment, and that practitioners, as well as people in recovery, families, and policy makers, should not be disappointed or discouraged by the fact that there are no quick fixes. Similar to (other) continuing care medical illnesses, previous treatment of a person’s condition is not taken to be indicative of a poor prognosis, of non-compliance, or of the person’s not trying hard enough to recover. Relapses in substance use are viewed as further evidence of the severity of the person’s condition rather than as causes for discharge (e.g., we do not discharge a person from the care of a cardiologist for having a second or third heart attack). All of these principles suggest that treatment, rehabilitation, and support are not to be offered through serial episodes of disconnected care from different providers, but through a carefully crafted system of care that ensures continuity of the person’s most significant healing relationships and supports over time and across episodes, programs, and agencies (Tondora, et al., 2008).Within this context, there is an important role for recovery support services to play in increasing an individual’s “recovery capital,” enabling him or her to benefit from treatment and rehabilitation. With the advent of motivational interventions, “hitting bottom” is no longer viewed as a prerequisite for abstinence. Rather, we understand that at least some “recovery capital” is required for people to undertake the difficult and prolonged work of recovery. Recovery support services are those services which enable people to acquire these various forms of recovery capital, whether that be through increasing motivation for change, obtaining stable housing, securing gainful employment, or finding a network of supportive friends.Additionally, relapse is a common event early in the treatment and recovery process, and there are points of heightened vulnerability later in the recovery process. The Recovery Management model acknowledges this vulnerability but suggests that relapse is not inevitable if the ongoing recovery process is actively managed.Recovery Management spans three phases in the recovery process: 1) pre-recovery identification and engagement, 2) recovery initiation and stabilization (recovery activities/treatment), and 3) recovery maintenance (post-treatment recovery support services).References:Tondora, Heerema, Delphin, Andres-Hyman, O’Connell, & Davidson (2008). Practice Guidelines for Recovery-Oriented Care for Mental Health and Substance Use Conditions, Second Edition. Connecticut Department of Mental Health and Addiction Services.White, W. (2007). Perspectives on Systems Transformation How Visionary Leaders are Shifting Addiction Treatment Toward a Recovery-Oriented System of Care. Chicago, IL: Great Lakes ATTC, Jane Addams College of Social Work University of Illinois at Chicago.White, W., Boyle, M.G., Loveland, D.L., Corrington, P.W. (nd). What is Behavioral Health Recovery Management? A Brief Primer. The Behavioral Health Recovery Management Project, Fayette Companies, Peoria, IL, Chestnut Health Systems, Bloomington, IL and The University of Chicago Center for Psychiatric Rehabilitation.
21 The language that we use They’re not readyThey don’t want it bad enoughThey haven’t hurt/lost enoughThey’re too resistantThey are in denial
22 “Those people” And then there is “Chronic Relapser” or AlcoholicAddictDrunkOld WinoCrack HeadJunkieNeedle FreakBenzo QueenGarbage HeadBurn OutPot HeadLoserWaste CaseAnd then there is “Chronic Relapser”or“Chronic Recidivist”
23 My clients don’t hit bottom; they live on the bottom My clients don’t hit bottom; they live on the bottom. If we wait for them to hit bottom, they will die. The obstacle to their engagement in treatment is not an absence of pain; it is an absence of hope. —Outreach Worker (Quoted in White, Woll, and Webber 2003)
24 Pathology vs. strength based “When I stopped living in the problem and began living in the answer, the problem went away” Alcoholics Anonymous p.449 (3rd Edition)
25 To sum it all upBy us changing our language we can start the process of the general public changing their language and perceptionWe need to bring unequivocal messages of hope that the problems of substance use disorders can be resolvedThe focus needs to be on the solutions that recovery bringsThe reality of recoveryThe diversity of patterns of recoveryThe variety of methods used to achieve recovery
26 If you have some respect for people as they are, you can be more effective in helping them to become better than they are John W. Gardner