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Designing Services for Recovery: Toward Sustained Recovery Management Designing Services for Recovery: Toward Sustained Recovery Management William L.

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Presentation on theme: "Designing Services for Recovery: Toward Sustained Recovery Management Designing Services for Recovery: Toward Sustained Recovery Management William L."— Presentation transcript:

1 Designing Services for Recovery: Toward Sustained Recovery Management Designing Services for Recovery: Toward Sustained Recovery Management William L. White, MA Chestnut Health Systems Bloomington, IL USA

2 Presentation Goals 1. Describe the contextual forces that are triggering the call for a fundamental redesign of addiction treatment 2. Outline how service philosophies and practices are changing within Recovery- Oriented Systems of Care (ROSC)

3 New Monographs White, W. (2008). Recovery management and recovery-oriented systems of care: Scientific rationale and promising practices. See White, W. (2009). Peer-based addiction recovery support: History, theory, practice, and scientific evaluation. See

4 Recovery Revolution Defined 1. Cultural/political awakening of communities of recovery 2. Emergence of recovery as an organizing paradigm for behavioral healthcare 3. Call for fundamental changes in the design of addiction treatment: Toward Recovery Management and Recovery- oriented Systems of Care

5 Recovery Mutual Aid Societies Growth in size and geographical dispersion Growth in size and geographical dispersion Philosophical diversification (religious, spiritual, secular; moderation-based) Philosophical diversification (religious, spiritual, secular; moderation-based) Group specialization by drug choice, age, gender, sexual orientation, occupation and co- occurring problems Group specialization by drug choice, age, gender, sexual orientation, occupation and co- occurring problems Growing varieties of recovery experience Growing varieties of recovery experience Sources: White & Kurtz, 2006, International Journal of Self Help and Self Care; White, 2004, Addiction; Humphreys, 2004, Circles of Recovery.

6 Recovery Community: Institution Building Recovery Community Organizations Recovery Community Organizations Recovery Homes and Colonies Recovery Homes and Colonies Recovery Schools Recovery Schools Recovery Industries Recovery Industries Recovery Ministries/Churches Recovery Ministries/Churches Recovery Community Centers, Recovery Social Clubs, Recovery Cafes Recovery Community Centers, Recovery Social Clubs, Recovery Cafes Source: White, 2008, Counselor.

7 Recovery Community: Cultural Development Cultural Consciousness Related to: History History Language Language Values Values Rituals of Celebration Rituals of Celebration Literature, Music, Cinema, Art Literature, Music, Cinema, Art Source: White, 1996, Culture of Addiction, Culture of Recovery

8 New Recovery Advocacy Movement Political awakening of people in recovery Recovery Summits Recovery Summits New and Renewed Recovery Advocacy Organizations New and Renewed Recovery Advocacy Organizations Kinetic Ideas Kinetic Ideas Advocacy and Anti-stigma Campaigns Advocacy and Anti-stigma Campaigns Recovery Month and Recovery Celebration Events (40,000+ US participants in Sept., 2008) Recovery Month and Recovery Celebration Events (40,000+ US participants in Sept., 2008) Source: White, 2007, Addiction.

9 Toward a Recovery Paradigm From Pathology (knowledge drawn from studies of addiction) and Intervention Paradigms (knowledge drawn from studies of treatment) to a Recovery Paradigm (knowledge drawn from collective experience & study of long-term recovery) Call for Recovery-Oriented Systems of Care Source: White, 2005, Alcoholism Treatment Quarterly; Clark, 2007; Kirk, 2007; Evans, 2007

10 Two Prevailing Models of Addiction Treatment 1. Acute care model that focuses on brief biopsychosocial stabilization without sustained recovery support. 2. Chronic care model that began with a vision of comprehensive rehabilitation for chronic heroin dependence

11 The Acute Care Model An encapsulated set of specialized service activities (assess, admit, treat, discharge, terminate the service relationship). An encapsulated set of specialized service activities (assess, admit, treat, discharge, terminate the service relationship). A professional expert drives the process. A professional expert drives the process. Services transpire over a short (and ever- shorter) period of time. Services transpire over a short (and ever- shorter) period of time. Individual/family/community are given impression at discharge (graduation) that recovery is now self-sustainable without ongoing professional assistance Individual/family/community are given impression at discharge (graduation) that recovery is now self-sustainable without ongoing professional assistance Source: White & McLellan, 2008, Counselor

12 The Chronic Care Model Vision: medication-assisted metabolic stabilization for chronic opioid dependence as a foundation for long-term biopsychosocial recovery Model Deterioration: dosing with inadequate clinical & peer recovery support for psychosocial rehabilitation and & community re-integration Focus: what is subtracted/reduced (drug-related problems, crime, disease risk/transmission) from clients life rather than what is added (e.g., global personal/family health, productivity, life meaning/purpose, citizenship and service)

13 Treatment Works Efficacy and effectiveness established via enhanced outcomes compared to no treatment or non-specialized treatment Lives of many individuals and families transformed through the medium of addiction treatment Effectiveness influenced by problem severity and complexity and recovery capital Source: Review in White, 2008 Monograph

14 Existing Treatment Works, But…. Weak attraction (less than 10% in any year; 25% in lifetime) Weak attraction (less than 10% in any year; 25% in lifetime) Delayed engagement (late stage & primarily through external coercion) Delayed engagement (late stage & primarily through external coercion) Compromised access (waiting lists & other obstacles) Compromised access (waiting lists & other obstacles) High attrition following Admission (more than 50%) High attrition following Admission (more than 50%) Inadequate dose/duration (less than dose linked to best recovery outcomes) Inadequate dose/duration (less than dose linked to best recovery outcomes)

15 Existing Treatment Works, But… Inadequate quality (limited in scope of services and by methods lacking scientific support) Inadequate quality (limited in scope of services and by methods lacking scientific support) Passive rather than assertive linkage to communities of recovery & high attrition Passive rather than assertive linkage to communities of recovery & high attrition Inadequate post-treatment continuing care (received by only 10-20% of clients) Inadequate post-treatment continuing care (received by only 10-20% of clients) High rates (50%+) of post-treatment relapse (most within 90 days of discharge) & high re- admission rates (25-35% within one year) High rates (50%+) of post-treatment relapse (most within 90 days of discharge) & high re- admission rates (25-35% within one year)

16 Existing Treatment Works, But… In the U.S, 64% of clients admitted to addiction treatment have one or more prior treatment episodes; 19% have 5 or more prior episodes In the U.S, 64% of clients admitted to addiction treatment have one or more prior treatment episodes; 19% have 5 or more prior episodes We are placing people in treatment whose design is incapable of generating sustainable recovery for many clients & then blaming the clients for that failure. We are placing people in treatment whose design is incapable of generating sustainable recovery for many clients & then blaming the clients for that failure. Sources: White, 2008 Monograph

17 Toward a Model of Sustained Recovery Management (RM) Pre-recovery identification and engagement Pre-recovery identification and engagement Recovery initiation and stabilization Recovery initiation and stabilization Sustained support for recovery maintenance Sustained support for recovery maintenance Support for enhanced quality of personal/family life in long-term recovery Support for enhanced quality of personal/family life in long-term recovery --Emphasis on peer-based recovery support services and indigenous community support --Emphasis on peer-based recovery support services and indigenous community support Source: White, 2009, Journal of Substance Abuse Treatment

18 Recovery Management: Emerging Elements Recovery orientation, e.g., mission, representation, service philosophy Recovery orientation, e.g., mission, representation, service philosophy Early engagement, e.g., assertive community outreach Early engagement, e.g., assertive community outreach Increased access & retention, e.g., streamlined intake, in-Tx recovery coaching and support services Increased access & retention, e.g., streamlined intake, in-Tx recovery coaching and support services Assessments that are global, strength-based & continual Assessments that are global, strength-based & continual

19 Recovery Management: Emerging Elements Rapid transition from treatment planning to recovery planning / choice philosophy Rapid transition from treatment planning to recovery planning / choice philosophy Expanded service team, e.g., inclusion of primary physicians, indigenous healers, recovery volunteers Expanded service team, e.g., inclusion of primary physicians, indigenous healers, recovery volunteers Assertive linkage to communities of recovery Assertive linkage to communities of recovery

20 Recovery Management: Emerging Elements Assertive approaches to continuing care (e.g., recovery checkups) for up to 5 years Assertive approaches to continuing care (e.g., recovery checkups) for up to 5 years Shift in helping role/relationship from expert to recovery consultant/partnership Shift in helping role/relationship from expert to recovery consultant/partnership Focus on building personal, family & community recovery capital, e.g. community development strategies Focus on building personal, family & community recovery capital, e.g. community development strategies Evaluation based on effects of multiple interventions on long-term addiction/treatment/recovery careers rather than immediate effects of single intervention Evaluation based on effects of multiple interventions on long-term addiction/treatment/recovery careers rather than immediate effects of single intervention

21 Closing Thoughts 1. ROSC and RM represent not a refinement of modern addiction treatment, but a fundamental redesign of such treatment. 2. Overselling what existing treatment models can achieve to policy makers and the public risks a backlash and the revocation of addiction treatments probationary status as a cultural institution.

22 Closing Thoughts 3. It will take years to transform addiction treatment into a model of sustained recovery support. 4. That process will require replicating what is already underway in many locations: aligning concepts, contexts (infrastructure, policies and system-wide relationships) and service practices to support long-term recovery for individuals and families.


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