1. + ReStart Collegiate Recovery Program: A Community Needs Assessment Kate Chiseri | Julia Jordan | Monika Ramnarayan | Anamika Satsangi | Emily Witt

2. + Welcome!

3. + Overview Background Key Informant Interviews Primary Data Collection Instrument ReStart Needs & Priorities Recommendations Limitations Lessons Learned Acknowledgements

4. + Definition of Recovery ReStart Minimum of 9 months of sustained sobriety from a substance use disorder

5. + What is ReStart? Initiative of the Division of Campus Life Managed by the Office of Health Promotion (OHP) Students in the recovery process while attending Emory Criteria for joining the Recovery House 1. Minimum of 9 months of sustained recovery & sobriety from a substance use disorder 2. Desire to work aftercare/recovery plan in a clean & sober space 3. Application & interview 4. Submission to random drug screening 5. Willingness to provide mentorship to other members of ReStart community 6. 12 step meetings with possibility of chairing meetings 7. Participation in ReStart events

6. + What does the literature say? Substance use: a critical public health issue among college-age youth (CDC, 2014) Alcohol use on college campuses 60.3% of college-age respondents (18-25) report heavy or binge drinking (NSDUH, 2012). Specific aspects of college environment encourage drinking (NIAAA, 2012). Georgia’s rates of alcohol and drug dependence at or below national rates for 18-25 age group (HHS, 2008) ~22% of college-age respondents reported use of illicit drugs (NSDUH, 2012) In a longitudinal study conducted in NC and VA, roughly 30% of students reported marijuana use when entering college (Suerkin et al., 2014). Marijuana and other drug use reduce chances of continuous college enrollment (Arria et al., 2013) Increasing prevalence of nonmedical prescription drug use (Arria & Dupont, 2010) Adderall, Ritalin, Concerta Alcohol UseIllicit Drug Use

7. + Substance Abuse vs. Dependency Recurrent substance use resulting in a failure to fulfill obligations at work, school, or home Recurrent substance use in situations in which it is physically hazardous Recurrent substance-related legal problems Tolerance Need for increased amounts of substance to achieve desired effect Diminished effect with the same amount of substance Withdrawal Characteristic withdrawal syndrome Taking the same or similar substance to relieve/avoid withdrawal symptoms AbuseDependency * The 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaces the use of the terms “substance abuse” and “substance dependency” with the overarching term “substance use disorder” (Rastegar, 2014).

8. + What does the literature say? Collegiate Recovery Programs “Support for students in recovery from addiction seeking a degree in higher education.” -Association of Recovery in Higher Education (ARHE) definition Campus-based support is provided through a positive social and community environment, relapse prevention, and promotion of academic performance (ARHE 2014)

9. + Midwest Region (8 programs) -Augsburg College StepUP Program (Minnesota) -University of Michigan Collegiate Recovery Program (Michigan) -St. Cloud State University Recovery Community (Minnesota) -Ohio University (Ohio) -The College of St. Scholastica Clean (Minnesota) Northeast Region (4 programs) -University of Vermont Collegiate Recovery Community (Vermont) -Penn State Collegiate Recovery Community (Pennsylvania) -Fairfield University (Connecticut) -Rutgers Alcohol & Other Drugs Assistance Program Recovery House (New Jersey) Southern Region (18 programs) -Kennesaw State University Student Success Services Center for Young Adult Addiction and Recovery (Georgia) -Georgia Southern University Center for Addiction Recovery (Georgia) -Emory University Office of Health Promotion ReStart (Georgia) -University of Georgia Collegiate Recovery Community (Georgia) -Texas Tech University Center for the Study of Addiction and Recovery (Texas) Western Region (7 programs) -University of California- Santa Barbara (California) -University of Nevada- Reno (Nevada) -Southern Oregon University (Oregon) -University of Oregon (Oregon) -Oregon State University (Oregon) Adapted from: http://collegiaterecovery.org/programs

10. + What does the literature say? Collegiate Recovery in Georgia Schools offering collegiate recovery programs: Collegiate Recovery Community at KSU Established January 2008 Supportive peer community within campus culture Addiction Education and Prevention programs

11. + Office of Health Promotion (OHP) Mission: “to facilitate student flourishing and build capacity for a Healthy Emory” 2012 – 2013 115 educational programs Contact with 3,150 students, 220 staff members, 30 faculty members Program focus areas: Sexual health promotion Sexual assault prevention Alcohol and drug usage Flourishing

12. + 2011 NCHA – 70.7% of Emory students reported having consumed alcohol in the past 30 days Gift from an anonymous donor in Spring 2014 to establish ReStart Office of Health Promotion Alcohol/Substance Use Frequency of Alcohol Use in the Last 30 Days, 2011 Emory Respondents (N=1,551) http://studenthealth.emory.edu/hp/alcohol_and_other_drugs/index.html

13. + CNA Purpose Assess need for a collegiate recovery program at Emory University Explore types of messaging that could improve the ReStart program Identify potential collaborative partners in the Emory community who may be able to help build safe, alternative spaces for recovering

14. + Guiding Questions Do students feel that recovery programs are needed at Emory University? How do members of the Emory community (faculty, staff, program directors, administrators) perceive the need for recovery programs at Emory University? How should the ReStart program begin to facilitate open communication around recovery from substance abuse?

15. + Community Definition Undergraduate, graduate and professional students attending Emory University Tertiary Level Needs Administrators & Policy Makers Secondary Level Needs ReStart Program Facilitators Primary Level Needs Emory Students in Recovery

16. + Community Profile Emory Community Demographics Community Social Environment Alcohol & Drug Abuse Policy Community Health Systems Community Health Status 14,513 students >50% female 14,513 students >50% female Health insurance for all students Majority say excellent, very good, or good Promotes diversity and health Guidelines for campus alcohol use

17. + Geographic Location (not included) http://map.emory.edu/

18. + Community Assets Office of Health Promotion Willie Bannister & Jessica Hill OHP Website Drink Like Dooley Donation to establish ReStart http://studenthealth.emory.edu/hp/

19. + Windshield Survey Purpose: to gain a more thorough understanding of the environment students in recovery might encounter on the Emory Campus and the current programming available to them Areas surveyed: Gatewood Neighborhood Eagle Row Office of Health Promotion ReStart webpage

20. + Windshield Survey Gatewood & Eagle Row Gatewood Road. Friday, September 19, 2014 at 10:30 AM Eagle Row. Friday, September 19, 2014 at 10:30 AM

21. + Key Informant Interviews

22. + Understand current practices of recruitment and assistance for collegiate substance abuse recovery programs Interviews informed best practices for ReStart Key Informants: Willie Bannister, Coordinator, ReStart Brooke Thyng, ReStart Housing Director Dr. James Spivey, Faculty Advisor for ReStart Lani Walsh, Offsite referral for substance use for substance use counseling Dr. Michael Huey, Executive Director, Student Health and Counseling Services Teresa Johnston, Director Center for Young Adult Addiction and Recovery, Kennesaw State University Jenna Parisi, National Advocate for Collegiate Recovery

23. + Key Informant Interviews Protocol Recruitment – purposive sampling, emails sent to prospective key informants Data Collection – most interviews were conducted in person (2 via phone) Verbal consent to have interview recorded Verbal consent to use their real name 2 interviewers present Semi-structured interview guides (ReStart affiliates, Administrators & Professionals) Data Analysis Thematic analysis using MaxQDA Inductive & Deductive Coding Data Management Members of the CNA team - only people with access to recorded interviews and transcriptions Once the project is complete, interview data will be deleted.

24. + Key Informant Interviews Sample Interview Questions What types of programs and assistance do you believe are necessary for college students to have a successful recovery? ReStart Affiliations Can you share some of your expert advice on organizing a collegiate recovery program? How have you garnered support from your school’s administration? How do you ‘advertise’ [collegiate recovery program]? Collegiate Recovery Professionals What are some challenges you have faced or anticipate as an administrator when collaborating with collegiate recovery programs? Administrators

25. + Themes Alcohol & Drug Use At Emory General College Environment “[Collegiate recovery programs are] critical in terms of neuroscience and what we know in the field, I think it’s also critical for the environment and the context that students find themselves in because often campuses are ‘recovery hostile.’ There is partying and cultures that make it very difficult for people to maintain sobriety when they aren’t seeing that modeled by their peers or talked about by their institutions.” -Jenna Parisi, Transforming Youth Recovery

26. + Themes Messaging & Promotion De-stigmatizing Recovery Awareness, Education & Outreach Presenting ReStart to Emory Administration “I think the students are going to have to be the ones to say we want this, we need this…The student voice matters much more typically than the staff members’ voices.” - Brooke Thyng, ReStart Housing Director

27. + Themes Needs Emory Community “Increased comfort in being able to talk about difficult things should be part of what one’s experience at this university should be about” -Willie Bannister, Coordinator of ReStart

28. + Themes Benefits “But people do come here, and they do have problems, and…if we’re going to make the commitment to help them succeed, excel and go out and, you know, positively transform the world, then we gotta have the support here that they need. So I think that [for] an Emory student who goes through [the] recovery process and is ready to come back, this is a really good thing for the university to do.” -Dr. Michael Huey, Director of Emory University Student Health For StudentsFor Emory

29. + Primary Data Collection Survey

30. + Primary Data Collection Survey Instrument Assess need for a collegiate recovery program at Emory Understand students’ perceptions of substance use Determine students’ knowledge of substance use Gauge students’ willingness to intervene in a friend’s substance abuse behaviors Identify students’ communication preferences

31. + Primary Data Collection Protocol Recruitment – Convenience sampling & snowball sampling Tables set up in the DUC & Rollins Cafe Survey sent via email to undergraduate acquaintances & BeWellExcel listserv Sample –68 students total Undergraduate students (n=47) Graduate students (n=21) Data Collection – Google Forms Verbal consent 5-10 minutes 24 questions Data Management Google Forms data exported into a password protected Excel and SPSS files Once the project is complete, all data will be destroyed

32. + Gender

33. + Race & Ethnicity

34. + As a student, how does Emory communicate most effectively with you? 97.1%

35. + Does Emory have campaigns or programs addressing substance use? 70.6%

36. + Substance Abuse is a problem at Emory University 52.9%

37. + Emory is effective in addressing substance abuse 13.2%

38. + Comfort discussing high risk use of substances with peers 53.7%

39. + Comfort discussing a peer’s need for help to address his/her substance abuse behaviors 52.2%

40. + Student Responses Definitions Substance Abuse Overuse and unhealthy use of substances Intentionally using alcohol or other drugs to the point where you are incapacitated/unable to control your actions Using a substance beyond recreational use Substance Dependency The need to consume substances to maintain a fully functional life The need to use substances in order to feel good or feel “normal” Being incapable of quitting use of an addictive substance without experiencing physical withdrawal symptoms

41. + Do you know someone who is dependent on/abuses substances? 47.1%

42. + Does Emory need a Substance Abuse Recovery Program? 67.6%

43. + Data Triangulation

44. + ReStart Needs: Housing Alternatives Administrative Support De-stigmatization of Substance Abuse & Recovery Funding ReStart-Sponsored Events Substance Abuse & Recovery Resources Student-led Initiatives Routine Evaluations Increased Promotion, Awareness & Messaging Education for Students about Substance Abuse & Recovery

45. + Priorities Administrative support More resources Student-led initiatives Promotion, awareness & messaging of substance abuse programs More education for students about substance abuse & recovery ReStart sponsored events on campus Routine evaluation to assess changing program and student needs Housing alternatives De-stigmatize substance abuse & recovery Increase Funding -- Importance High Low Feasibility High Low

46. + Recommendations Administrative Support Have students present to voice need & desire for recovery program Emphasize how recovery program aligns with Emory’s mission Share program progress, evaluation & results with administrators to keep them informed

47. + Recommendations Substance Abuse & Recovery Resources Utilize current campus resources Faculty & Staff Office of Health Promotion Counseling Services Housing and Residence Life Advocate for recovering students the same way in which other minority (e.g. LGBT, religious minorities) student groups are promoted Increase ReStart Staffing REAL student

48. + Recommendations Student-led Initiatives Recruit student leaders to speak about their experiences Have students address administration directly Involve students in ReStart program development and implementation Peer education about substance abuse & recovery

49. + Recommendations Increased Promotion, Awareness & Messaging for ReStart Email & social media Distribute fliers and pamphlets around campus Host a table at Wonderful Wednesday with information about ReStart Create a display and distribute information about ReStart on the Rollins School of Public Health bridge during Mental Health Awareness Week (Spring) Utilize student orientations to distribute information about ReStart

50. + Recommendations Education for Students about Substance Abuse & Recovery Utilize the Office of Health Promotion New campaign to target high-risk drinkers Advertise across undergraduate and graduate campuses Disseminate information to high-risk groups (e.g. Greek life, incoming freshmen, etc.)

51. + Recommendations Housing Alternatives Provide alternative housing options for ReStart New ReStart residential option to decrease isolation Hire a housing director with experience in substance abuse & recovery and equip them with resources for possible relapse

52. + Recommendations De-stigmatization of Substance Abuse & Recovery Educate student leadership Create a stronger presence of ReStart on campus Enlist “Student Champions” to advocate for recovery efforts and needs

53. + Recommendations Funding Apply for $10,000 grant through Transforming Youth Recovery Rollins Grant Proposal Writing course Reach out to Alumni & other community members Charter ReStart as a student group on campus

54. + Recommendations ReStart-Sponsored Events Increase awareness of ReStart through campus- wide events Sober weekend socials Educational Sessions Outside Lecturers Have some events staffed by student leaders to increase attendance and student involvement

55. + Recommendations Routine Evaluations Conduct evaluations to assess changing needs Rollins Conduct of Evaluation Research course Present results to administration for continued support

56. + Limitations Time constraints A whole CNA in 3 months?!?! Scheduling conflicts No qualitative focus groups and/or interviews to complement quantitative data Windshield survey only at one time point Sampling Purposive sampling (Snowball) Convenience sampling Small sample size Graduate students are underrepresented Self-Report

57. + Lessons Learned Flexibility & time management Keep it simple Group collaboration is key – and we are the lucky ones! Provide better incentives for primary data collection

58. + Acknowledgements Dr. Dawn Comeau Jerrica Hampton Willie Bannister Dr. Michael Huey Dr. James Spivey Lani Walsh Jenna Parisi Brooke Thyng Teresa Johnston Heather Zesiger Jessica Hill Our supportive friends & classmates

59. + Questions? ReStart team at Fall Fling

60. + References Arria, A. M. and R. L. DuPont (2010). "Nonmedical Prescription Stimulant Use among College Students: Why We Need To Do Something and What We Need To Do." J Addict Dis. 29(4): 417-426. Arria, A. M., et al. (2013). "Drug use patterns and continuous enrollment in college: results from a longitudinal study." J Stud Alcohol Drugs 74(1): 71-83. Association of Recovery in Higher Education (2014). "Recovery Programs." Retrieved September 25, 2014. Centers for Disease Control and Prevention (2014). "Six Tips for College Health and Safety." Retrieved September 20, 2014. Emory University and Office of Health Promotion (2014). "About." Retrieved October 3, 2014, from http://studenthealth.emory.edu/hp/about/index.html. http://studenthealth.emory.edu/hp/about/index.html. Kennesaw State University (2013). "Center for Young Adult Addiction and Recovery." Retrieved September 25, 2014. NIH National Institute on Alcohol Abuse and Alcoholism (2014). "College Drinking." Retrieved September 20, 2014. Rastegar, D. (2014). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 Replaces DSM-IV. from http://www.bu.edu/aodhealth/issues/issue_sept13/rastegar_dsm5.html http://www.bu.edu/aodhealth/issues/issue_sept13/rastegar_dsm5.html Services, U. S. D. o. H. a. H. (2008). States In Brief: Substance Abuse and Mental Health Issues At-A-Glance. http://www.samhsa.gov/data/StatesInBrief/2k9/GEORGIA_508.pdf. http://www.samhsa.gov/data/StatesInBrief/2k9/GEORGIA_508.pdf. Services, U. S. D. o. H. a. H. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD, HHS. Suerken, C. K., et al. (2014). "Prevalence of marijuana use at college entry and risk factors for initiation during freshman year." Addict Behav 39(1): 302-307.

61. + Image References http://www.ok.gov/odmhsas/Mental_Health_/Certifications,_Credentialing_and_Training/Recovery_Support_Specialist/ http://www.allaboutcounseling.com/ http://universityprimetime.com/top-10-college-drinking-games/ http://www.recoveryconnection.org/recovery-blog/support-for-addiction/a-new-definition-of-recovery-from-addiction/ http://www.emory.edu http://www.kennesaw.edu/ http://www.georgiasouthern.edu/ http://www.uga.edu/ http://studenthealth.emory.edu/hp/ http://studenthealth.emory.edu/hp/alcohol_and_other_drugs/index.html http://www.addictionsearch.com/treatment_articles/article/overview-of-substance-abuse-and-addiction-recovery_307.html http://map.emory.edu/ http://studenthealth.emory.edu/hp/alcohol_and_other_drugs/if_you_drink_drink_like_dooley.html http://kool98.com/chris-johnson/funny-way-to-handle-having-broken-windshield-wipers/ http://www.vectorstock.com/royalty-free-vector/footprints-vector-702583 http://www.strongchurch.org/a-whole-month-of-thanks/