This podcast involves three of my favorite people. It’s a conversation about recovery in the context of community. It’s brief and well worth your time. Enjoy!

• Derek Wolfe created and hosts Vital Discussions. He’s a medical student who will be starting a psychiatry residency soon. The podcast focuses on the medical community. We met when he was working on an article about the healing forest concept and later worked together at Dawn Farm.
• Matt Statman has contributed to Recovery Review and is the manager of the Collegiate Recovery Program at University of Michigan.
• Anna Byberg and I worked together at Dawn Farm where she is now the clinical director.

Journal For Advancing Justice Vol. III Now Available

Emerging Best Practices in Law Enforcement Deflection and Community Supervision Programs

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For those of us who work in treatment courts and the larger justice system, we know the crucial roles played by both law enforcement and community corrections professionals. What we know less about, however, is the emerging field of law enforcement deflection and prearrest diversion, as well as what constitutes best practices for effective community supervision. In both areas, research, evaluation, and practical insight are needed to help shape an improved justice response to people with substance use and mental health disorders in our communities.

NADCP’s Journal for Advancing Justice is a peer-reviewed scholarly journal that provides evidence-based and promising practices on the most pressing issues facing the justice system today. We are thrilled to announce the publication of Volume III: “Emerging Best Practices in Law Enforcement Deflection and Community Supervision Programs.”

Funded by the White House Office of National Drug Control Policy, this volume addresses programs and interventions designed to assist individuals with mental health and substance use disorders who come to the attention of law enforcement and community corrections programs. It also analyzes community supervision practices to contribute to the research on effective strategies for probation, parole, and pretrial supervision programs. Through a range of articles written by both researchers and practitioners, this issue provides insight and analysis to assist justice professionals in identifying promising programs and interventions as well as areas that require further investigation to solidify them as best practices.

We hope this journal will be a valuable resource as you strive to better serve justice-involved individuals.

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The post Journal For Advancing Justice Vol. III Now Available appeared first on NADCP.org.

Which teachers were the best when you were at school? Likely the ones who believed in you, connected with you, who had a vision for where you could go and who enthusiastically helped you get there. I remember struggling with maths at school – I was always a writer, not an adder. Unfortunately I needed a higher level maths qualification to get to medical school.

Good teachers got me there. The same characteristics – vision, enthusiasm, affirmation, belief patience, engagement and holding out hope when there may not be much around, are likely to define the best clinicians too.

Limitations of treatment

In 2014, Pillay, Best and Lubman took a look at Australian clinicians’ attitudes to recovery in a research paper. They started by looking at the limitations of treatment

• Lack of consistency between episodes of treatment
• Focussing on a primary problem rather than addressing social, health and legal issues
• Lack of involvement of families
• Lack of referral to mutual aid

Now I have to say those themes are just as relevant today as they were six years ago. Perhaps more so.

What is ‘recovery’?

Plenty of definitions exist, but lack of agreement on what recovery actually is can be a problem. The role of abstinence is seen as contentious by some. As recovery is often seen as a process, say the authors, it is difficult to measure and may be better captured by a set of principles.

The study background

The authors explain the context to the study: research supports the idea that clinician attitudes can influence client outcomes, where clinicians who are more positive about being able to support client recovery achieve better client recovery outcomes. Conversely, ambivalent or negative clinician attitudes are associated with increased client relapse and reentry into treatment.

I remember a manager of a service saying to me a few years ago, when those with substance use disorders still had to turn up at the Benefits Agency to claim benefits, that if his clients could out out of bed and get there, that was recovery as far as he was concerned. I remember thinking ‘that’s surely a low bar’.

Clinician attitudes

The aims of this paper are fourfold:

1. What do clinicians think ‘recovery’ means?
2. What do they think are the risks and benefits of moving to a recovery-oriented approach?
3. Do service types and other variables influence attitudes?
4. Finally, what are clinicians’ expectations that their clients will eventually achieve recovery?

The study

Fifty alcohol and other drug clinicians from a variety of backgrounds completed questionnaires. Thirty-five of them also took part in structured interviews.

Definition of recovery

Just over a third said that recovery was ‘moderate controlled use of any drug and alcohol’. A further third said ‘no use of any drug or alcohol’ with the rest in between or not answering.

Risks and benefits of a recovery approach

There was much agreement of the potential benefits, with residential treatment providers being most positive. On the other hand, some said, ‘that’s what we are doing already’ (always sends up a red flag for me) and expressed concerns that if clients didn’t have recovery goals, then recovery services may seem to exclude them. The balance of harm reduction services and recovery services was also highlighted and the place of 12-step groups ‘imposing recovery’ was mentioned – whatever that means. Could it be the ‘high bar/low bar’ issue again?

Expectation of recovery

Just over half made a stab at estimating the proportion of clients they thought would eventually achieve lasting recovery. The clinicians reckoned about a third of their clients would get there. The world literature suggests it’s about half. In studies professionals consistently underestimate what their clients want and are capable of.

Study Conclusion 

The authors conclude that the term recovery is a contentious one, with many different interpretations and associated attitudes. They suggest that as services embrace change, it will be worth taking time to work with clinicians to create an atmosphere which is conducive to a Recovery Oriented System of Care. To help the process, rather than trying to pin down ‘recovery’ precisely, an ‘overarching set of principles’ will be more useful. Getting recovering people involved in the discussion will be an important catalyst.

Reflections

It’s interesting to me (but not surprising) that residential treatment providers were the most positive about a recovery approach. We get to see lives transformed through the process of recovery and, in aftercare and beyond, see recovery being sustained. That’s not always something colleagues in different parts of services see.

Getting recovery-oriented systems of care established and working well has been highlighted as important in the last drugs policy and in this one. Everything joined up from harm reduction services (drug consumption rooms for instance) to residential rehab and community recovery resources. Would be good to see these operational across Scotland.

This theme of the importance of lived experience detailed in this study (embedded in the Scottish Government’s drug policy Rights, Respect, Recovery) is welcome. The recently-appointed drugs minister, Angela Constance MSP, has just tweeted a commitment to that very thing which can only be welcomed.

Irene Pillay, David Best & Dan I. Lubman (2014) Exploring Clinician Attitudes to Addiction Recovery in Victoria, Australia, Alcoholism Treatment Quarterly, 32:4, 375-392, DOI: 10.1080/07347324.2014.949126

This is an updated version of a previously published blog.

Our substance use care infrastructure and workforce has never been in particularly good shape. It is largely held together by passionate people who care about the work and who serve in the face of a myriad of barriers and challenges. It is a constant upstream swim even in the best of times. This is a result of systemic negative perceptions about substance use disorders, the people who have it and the workforce that serves them.

I have become increasingly concerned in recent years about the lack of longevity in our workforce and high rates attrition and the impact of these dynamics on the quality of care provided. These trends have both increased, and from my perspective largely are a result of high administrative burden, low compensation and an aging workforce, all exacerbated by the underling stigma against the disorder and everything related to the work. As a result, there are few us who stick and stay long enough to develop some level of mastery and insight into how our care systems integrate and relate to the rest of healthcare. We are losing institutional knowledge and it is not being replaced. Even before COVID-19, this SAMHSA Behavioral Health report indicated we will need around a million and a half counselors and a million peer support professionals. This is a huge problem.

And now we have the confluence of contagions – the addiction epidemic as it unfolds in the midst of the COVID-19 pandemic. News reports highlight the grim reality that our healthcare systems are being pushed beyond the brink. COVID patients are being treated in hospital gift shops or triaged and left to die at home if they are viewed as unlikely to survive with medical intervention. If this is occurring across the US medical healthcare system – the best funded in the world as we spend many multitudes of what other nations do on healthcare. What will our ragtag SUD care system face with the coming waves of addiction in coming years? 

There are hints. This New York Times article “Relapsing Left and Right: Trying to Overcome Addiction in a Pandemic” indicates we have already lost up to 10% of our treatment capacity and nearly half of the facilities are operating at around half capacity. We need to understand the context under which the influence of the COVID-19 pandemic will have on addiction rates here in America. We know people are using more substances to sooth anxiety, even as a large segment of our population is being exposed to significant trauma, both which will tend to increase addiction rates. This is a dynamic that will play out at increased rates over the next decade.

So I am left with more questions than answers. Without serious investment and redesign oriented towards long term wellness, we will simply not be able to handle what is coming at us. We need to strengthen our foundations and build out a functional care system in consideration of long-term needs. It would be hard to argue we have made much progress towards that end as our care system is already withering under the initial pressures of what will be a decade long impact at best.

A full redesign of a care system oriented towards recovery could only come from serious investment in resources. We can do things now which would help set up an environment to support a more robust system. We could get rid of the IMD Exclusion, set aside dedicated funding for authentic recovery community organizations and require insurance companies on the private side to fund more than acute care models. I put together set of things to consider related to a longer term care model here. 

Typically, when such policy reports are developed, a small group of well-meaning people is pulled together and they churn out a white paper. It gets published and becomes a dust collector. We need to think and act bigger to save lives and resources. We should start with a broad discussion of system redesign modeled on the mentality that recovery is the probable outcome across all our communities and then design and implement care that achieves this goal inclusive of the diverse communities impacted by addiction. A model that contains harm reduction measures, acute treatment, long term recovery support and is consistent with the diverse needs of all our communities. While this is the vision – the answers are going to involve all of us. What will drive it if anything is the imperative to address what is coming at us.

The clock is ticking and what we do now will impact what happens as the devastation plays out over the coming decade.

Drink does not drown care, but waters it, and makes it grow faster

Benjamin Franklin

When we consider the things that make us vulnerable to addiction – trauma, poverty, lack of opportunity, stress, stigma, genetics and environment, it’s no surprise that relapse and the development of problems with other substances occur after treatment. These problems don’t resolve quickly, if at all.

The attempt to soothe cares, pain and distress with alcohol, the permitted drug, is understandable. I hear stories every week from my patients about their experiences of putting down one substance and picking up alcohol (or other drugs) only to find their problems worsening.

Last year, I took a look at the issue of risks of developing an alcohol problem for those in recovery from other substance use disorders. It seemed as if they were significant.

In their recently published study, Greg Rhee and Robert Rosenheck have helped to quantify this risk this a bit more. They sought to estimate how common alcohol use disorder (AUD) was in those who had recovered from other substance dependence.

Context

As the authors say, individuals who use one substance ‘are recognised to be at greater risk of using other, often multiple, substances’. Previous research suggested that ‘alcohol use, especially heavy drinking, may be overlooked and underestimated among patients recovering from substance misuse’. Alcohol consumption has also been linked to increased risk of relapse back to the drug of choice, but it has been difficult to quantify risks.

What they did

The researchers took a look at data from just over 2000 adults who had previously suffered from substance use disorders (e.g. opiates, cocaine and other stimulants) but who were now in recovery. They divided this group into three – those who had no history (past or present) of alcohol use disorder (AUD), those who had a past, but not current, history of AUD and those who currently met the criteria for AUD. Then they looked at relevant factors for all three categories, such as other diagnoses, demographics and quality of life indicators.

Interestingly, the largest group in the sample was those with cannabis use disorder (60%), followed by cocaine use disorder (31%) and stimulant use disorder (21%) with only 17% having an opioid use disorder.

Findings

More than three quarters had either a current (29%) or a past, but recovered (48%), AUD. Less than a quarter (23%) had no history of AUD. Those who had a current medical or mental health problem were more likely to have a current AUD. They were also less likely to be married and more likely to be a bit younger.

What does it mean?

It means that a significant proportion of the people recovering from non-alcohol substance use disorder seem to be at risk of AUD. 

Alcohol use disorder is the most common co‐occurring lifetime substance disorder among those recovered from substance use disorder

Rhee and Rosenheck 2020

Although the distribution of the problem substances in this population would certainly seem not to be typical of a Scottish treatment population, limiting generalisability (there are other limitations listed in the paper), there are lessons here. 

Statutory treatment provision here has been criticised as focussing on opioid treatment in a service-user group who are often suffering from problem poly-substance use. This is a broad generalisation, but could we do better, given the evidence on poly-substance use risk seen in our drug-related deaths data? In particular, based on this study, it looks like we need to look at alcohol risks. Service users need and deserve to have information about this.

What would help is to have clear policies, practice and education to try to reduce risk, to screen for AUDs, to treat co-occurring AUDs and to allow service users to hear peer experiences on the issue. Some of this is happening already – in my place of work, this comes up again and again and is a topic in our educational programme. 

This study helps us begin to put some flesh on the bones of the issue and ought to inform policy and practice.

Rhee TG, Rosenheck RA. Alcohol Use Disorder Among Adults Recovered From Substance Use Disorders. Am J Addict. 2020 Jul;29(4):331-339. doi: 10.1111/ajad.13026.

Photo credit istockphoto.com/ilze79 – under licence

We’ve finally made it to 2021—a new year, a clean slate, a great time to start over. Whether this is your first time or fifth time going through the 12 Steps of Alcoholics Anonymous or Narcotics Anonymous, the very first step remains just as important every single time. The first step is the beginning of an exciting journey to healing and recovery.

We admitted we were powerless over drugs and alcohol—that our lives had become unmanageable.

Substance use disorder (SUD) is cunning and baffling. It speaks to you in your own voice and can lead you to believe that you can manage the complications caused by substances on your own. The truth is, you can’t out-think the disease. It fills you with shame, guilt, and other negative feelings that cloud your judgment about yourself and the world around you.

Attending a treatment facility or beginning to attend AA or NA meetings can be the start of the first step for someone suffering from SUD. Other times, individuals may begin doing those things to appease others such as their family members and friends, instead of truly seeking a genuine path to recovery. For recovery to “stick”, you must come to a full surrender. You must be honest with yourself, open with others, and willing to do the work that it takes as your time in recovery goes on.

In the circumstance of recovery, surrender is an incredibly powerful thing. In this vulnerable moment of truth with yourself when you accept that you cannot manage your disease alone, you open yourself up to begin your new life.

Though the word may play on some of your insecurities, powerlessness over drugs and alcohol doesn’t make you weak. Recognizing powerlessness actually empowers you to make a change in your life. The courage that it takes to admit this requires immense strength. In this humble moment of asking for help, you have given yourself the opportunity that is sobriety and recovery. Acceptance that you have a problem, and that you need the guidance and wisdom of a higher power and others to heal is the true beginning of the first step.

Step 1 doesn’t require you to immediately fix everything in your life that you’ve broken, it doesn’t ask you to do a massive overhaul and change everything right away or “get better” overnight. It simply asks you to accept that you have a problem, admit that you can’t fix it on your own and that you need help. It also is important that you seek these truths for yourself and no one else. The beautiful thing about the 12 Steps is that they are designed to lead you to a slow and steady understanding of recovery and rebuilding your life at your own pace.

You should talk to your sponsor or a close contact in your recovery network about working the steps. It is important to seek the wisdom of someone who can provide you with guidance and a full understanding of the situation–another person in the program (AA or NA) with afflictions similar to yours who is compassionate and can help you understand the meaning and importance of each step.

***

For more information, resources, and encouragement, “like” the Fellowship Hall Facebook page and follow us on Instagram at @FellowshipHallNC.

About Fellowship Hall

Fellowship Hall is a 99-bed, private, not-for-profit alcohol and drug treatment center located on 120 tranquil acres in Greensboro, N.C. We provide treatment and evidence-based programs built upon the Twelve-Step model of recovery. We have been accredited by The Joint Commission since 1974 as a specialty hospital and are a member of the National Association of Addiction Treatment Providers. We are committed to providing exceptional, compassionate care to every individual we serve.

Event Description

Event Description

Event Description

Dr. Reid Hester is a psychologist and researcher.  He is the founder and director of the science division of CheckUp & Choices.  Reid’s extensive research in alcohol abuse has led to professional opportunities and collaborations with many experts in the field.  One long-standing partnership has been with SMART Recovery. 

In this podcast, Reid talks about:

• His educational background and path to earning a doctorate in psychology
• Meeting the “rising star” Dr. William Miller in Albuquerque, New Mexico in 1978
• Finding a kindred spirit in Dr. Tom Horvath, a founding member of SMART Recovery
• Publishing findings from a drug and alcohol abstinence focused protocol, in conjunction with SMART, in the Journal of Medical Internet Research
• How the pandemic is affecting recovery
• The CheckUp & Choices approach and app
• Receiving funding for continued research through Small Business Innovative Research Grants
• Carpe diem is the term when looking for web-based applications to make changes
• Future innovators including Chess Health and Vorvida
• Reasons to be hopeful and optimistic in recovery
• The positive ripple effect

Additional resources:

Click here to find all of SMART Recovery’s podcasts