1. Detroit Recovery Oriented Systems of Care Implications for Prevention Calvin R. Trent Ph.D. General Manager City of Detroit Department of Health and Wellness Promotion Division of Special Population Health Services

2. Brief Profile: City of Detroit (“A County Within a County”) Population: 951,270 (largest city in the State of Michigan)Population: 951,270 (largest city in the State of Michigan) Racial/Ethnic Composition: 82% African-American, 10% White, 5% Hispanic, 1% Asian, <1% American IndianRacial/Ethnic Composition: 82% African-American, 10% White, 5% Hispanic, 1% Asian, <1% American Indian Estimated Number of People Addicted: 10-12% (or 90,000-108,000)Estimated Number of People Addicted: 10-12% (or 90,000-108,000)

3. Detroit: Drug Abuse Patterns and Trends Cocaine is the foremost primary illicit drug of abuse among admissions to treatment programs.Cocaine is the foremost primary illicit drug of abuse among admissions to treatment programs. Users tend to be over 30, African- American or White, and of low socioeconomic status.Users tend to be over 30, African- American or White, and of low socioeconomic status. Cocaine (including crack) was involved as either primary, secondary, or tertiary drug in 52% of all treatment admissions in Detroit/Wayne County in FY2002, and 50% in FY2003.Cocaine (including crack) was involved as either primary, secondary, or tertiary drug in 52% of all treatment admissions in Detroit/Wayne County in FY2002, and 50% in FY2003.

4. Detroit: Drug Abuse Patterns and Trends (cont’d) Heroin is the second foremost primary illicit drug of abuse among admissions to treatment programs.Heroin is the second foremost primary illicit drug of abuse among admissions to treatment programs. Users are typically male, over the age of 30, African-American and of low socioeconomic status.Users are typically male, over the age of 30, African-American and of low socioeconomic status. Heroin was involved as the primary drug in 29% of all treatment admissions in Detroit/Wayne County in both FY2002 and FY2003Heroin was involved as the primary drug in 29% of all treatment admissions in Detroit/Wayne County in both FY2002 and FY2003

5. Detroit: Drug Abuse Patterns and Trends (cont’d) Marijuana also accounts for admissions to treatment programs in the city of Detroit.Marijuana also accounts for admissions to treatment programs in the city of Detroit. Users are typically adolescents or youngUsers are typically adolescents or young adults, and predominantly male. adults, and predominantly male. Marijuana was involved as primary, secondary, tertiary drug in 29% of all treatment admissions in Detroit/Wayne County in FY2003.Marijuana was involved as primary, secondary, tertiary drug in 29% of all treatment admissions in Detroit/Wayne County in FY2003.

6. Detroit Coordinating Agency (CA) Coordinates substance abuse treatment and prevention services through the current network of 45 treatment and 33 prevention providers.Coordinates substance abuse treatment and prevention services through the current network of 45 treatment and 33 prevention providers. One of 15 specialized local public or quasi-public entities called Coordinating Agencies.One of 15 specialized local public or quasi-public entities called Coordinating Agencies. The Detroit CA (that is, the Bureau of Substance Abuse Prevention, Treatment and Recovery) is organizationally placed within the Detroit Department of HealthThe Detroit CA (that is, the Bureau of Substance Abuse Prevention, Treatment and Recovery) is organizationally placed within the Detroit Department of Health

7. Detroit Coordinating Agency (CA) (continued) and Wellness Promotion (DHWP). and Wellness Promotion (DHWP). The Michigan Medicaid behavioral health “carve-out” model has been in existence since 10/1/98.The Michigan Medicaid behavioral health “carve-out” model has been in existence since 10/1/98.

8. The Old Paradigm: Treatment As Usual The target of service in the Acute Care Model of substance abuse interventions is the individual. The interventions associated with this model are designed to: o Alter the beliefs and behaviors thought to sustain addiction, and o Lower the biological vulnerability to addiction.

9. Recovery-oriented Systems of Care Recovery-oriented systems of care (ROSC) are networks of formal and informal services developed and mobilized to sustain long-term recovery for individuals and families impacted by severe substance use disorders. The system in ROSC is not a treatment agency but a macro level organization of a community, a state or a nation.

10. Recovery Management “ Recovery management” (RM) is a philosophical framework for organizing addiction treatment services to provide pre-recovery identification and engagement, recovery initiation and stabilization, long-term recovery maintenance, and quality of life enhancement for individuals and families affected by severe substance use disorders.

11. Looking Forward: Recovery Management Model of Care Individuals with Alcohol and other Drug problems are nested within complex relationships between: o Family o Culture o Society

12. Recovery Management Each level of this social ecosystem can contribute to the development of, help resolve, or sabotage resolution of AOD problems. Recovery Management interventions target the whole ecosystem rather than the individual.

13. Recovery Management Recovery Management moves beyond the clinical skills of assessment, diagnosis, and treatment of individuals to encompass: o Family reconstruction o Community resource development o Nation building

14. RM with Communities of Color Premised on the belief that the community oIs experienced through group solidarity with a historical and geographical community oIs an essential dimension of personal healing and prevention of negative behaviors

15. RM with Communities of Color From a Recovery Management perspective, Prevention efforts with communities of color must not segregate the threat of addiction from the multiple risks associated with the lives of individuals.

16. RM with Families of Color Addiction is but one wound families of color have suffered via the intergenerational transmission of historical trauma o The forced breakup of family units in slavery o Indian boarding schools and their aftermath The family unit itself needs a sustained process of recovery from these wounds.

17. RM with Families of Color The addiction-related transformation of family roles, relationships, rules, and rituals is deeply imbedded within family members and habitual patterns of family interaction and will not spontaneously remit with recovery initiation

18. RM with Families of Color Developmental stages of family recovery (over first 3 to 5 years) oPersonal healing oRealignment of family subsystems  adult intimate  parent-child  sibling oFamily’s relationship with the outside environment

19. RM with Families of Color Sustained recovery monitoring and support for family members (particularly the youth) is as crucial as it is for the individual recovering from severe AOD problems. Families that do not have sufficient supports to make these difficult transitions risk o Continuing the intergenerational cycle of addictive behaviors in the children o Disintegration

20. Resources for Recovery Management Individuals must have resources to initiate and sustain the recovery process. Ultimate goal of RM is to expand each community’s natural prevention and recovery support resources: o Physical o Psychological o Social

21. Resources for Recovery Management We call these resources Recovery Capital, defined as: o The quantity and quality of internal and external resources that one can bring to bear in the initiation and maintenance of recovery.

22. Resources for Recovery Management Successful Prevention strategies must include the development of resources to sustain the motivation to reject AOD as a lifestyle choice. We call these resources Prevention Capital, defined as: o The quantity and quality of internal and external resources that one can bring to bear in support of rejecting AOD use as a lifestyle option.

23. RM, Resources, and Youth Building a community that is replete with natural recovery support resources will also be one that naturally promotes the development of Prevention Capital in its youth.

24. Strategies to Improve Recovery Resources o Introducing youth and families to local communities of recovery o Conducting recovery-focused family and community education o Seeding local communities with visible recovery role models o Advocating pro-recovery social policies at all levels of government o Normalizing conversation about AOD in cultural institutions (Churches, School, etc.)

25. For more information, please visit our website at www.drugfreedetroit.org