Building a Common Vision for Recovery in America Michael T. Flaherty, Ph.D. Pittsburgh, Pennsylvania White House Compassion in Action Roundtable September 20, 2007

What is a Recovery Perspective? Substance dependence, while often manifested by socially unacceptable behavior (for which there must be responsibility), is at heart an illness. This illness can best be prevented when science is used to inform grassroots, community-based efforts to protect and build resiliency. The illness is best treated by early identification and intervention or, if not halted before its acute development, by a continuity of care over a lifetime that is built on measures of individual wellness and an ongoing opportunity and plan for recovery.

What Does Science Say? Millions of Americans today receive health care for mental health or substance use problems and illnesses. These conditions combined are the leading cause of disability and death among women and the second highest among men. – Institute of Medicine, 2006 Treatment Can be Effective When given a continuum of care, relapse rates for the treatment of alcohol, opioids, and cocaine are less than those for hypertension and asthma and are equivalent to those of diabetes (all of which are also chronic illnesses). Compliance to addiction treatment is greater than compliance rates for treatment of hypertension and asthma. – O’Brien and McLellan, 1996

What Does Science Say? (continued) Treatment is Effective and Sustainable Addictions treatment has resulted in:  67% reduction in weekly cocaine use,  65% reduction in weekly heroin use,  52% decrease in heavy alcohol use,  61% reduction in illegal activity, and  46% decrease in suicidal ideation one year post treatment. These outcomes are generally stable for the same clients five years post treatment. – Hubbard, 2003

Continuing Care is Cost Effective A recent study of a lifetime simulation model (multiple episodes of treatment over a lifetime) shows that for every $1 spent on treatment (chronic care provided in a continuum of care) society accrues $37.72 in benefits. – Zarkin et al., 2005

What is Recovery? Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. – CSAT National Recovery Summit, 2005 Recovery is not simply sobriety. While sobriety is considered necessary for recovery, it (alone) is not considered recovery. The WHO measures six domains of recovery: physical, psychological, independence, social, environmental and spiritual. – Betty Ford Institute Recovery Consensus Panel, 2007

What Does the Recovery Research Tell Us Thus Far? Recovery Supports:  Increase entry and involvement in treatment – Moos & Moos, 2005  Can be the basis for self and peer care shown to be effective in addressing any illness requiring continuing care – Flaherty, 2006  Are often low-cost or free (such as peer-support groups, recovery mentors, recovery check-ups, et al.) – McKay, 2005  Reduce chronicity (reoccurrence/relapse) and diminish stigma – Moos & Moos, 2005

What Does the Recovery Research Tell Us Thus Far? Recent data from Access to Recovery Projects shows statistically significant improvement when recovery supports are added to treatment in:  Overall treatment outcome  Treatment completion  Housing/homelessness  Employment  Criminal justice involvement -Gulf Coast ATTC, 2007

Building a Common Recovery Research Vision Understanding recovery better can help us strengthen the general understanding, prevention, intervention and treatment of addiction (Wm. White, FaVoR, IRETA) Future Recovery Research Questions to Explore:  How and where does recovery begin?  Once recovery begins, how is it sustained?  What is the true magnitude of recovery in America? (incidence (# of new cases/yr + prevalence) – reoccurrence/yr = total in recovery)  Who is and is not achieving recovery (age, race, ethnicity, principle language, gender, etc.)?

Building a Common Recovery Research Vision (cont’d) What sustains recovery and does this differ with the  What sustains recovery and does this differ with the mode of recovery supports (religious, spiritual, mode of recovery supports (religious, spiritual, secular) or the way recovery is achieved (natural, secular) or the way recovery is achieved (natural, recovery mutual aid, professional)? recovery mutual aid, professional)? Is abstinence the only monitor of recovery?  Is abstinence the only monitor of recovery? One day all Americans will begin to see the value of quality health care by the light and measure of its successes and not just by the darkness of its failures.

When all in the field (practitioners, policy makers, researchers, and others) use an understanding of recovery to inform the science and practice of prevention, early intervention and treatment, our larger understanding of addictions will completely change and lead to previously unimagined, more effective methods that address substance use and build recovery. Thank You! Michael T. Flaherty, Ph.D.