Improving Client Outcomes: Using Core Correctional Practices in Treatment Courts
October 21 or November 12; 2:00 p.m. Eastern
NADCP is pleased to present a webinar on Core Correctional Practices on Wednesday, October 21 and will repeat it Thursday, November 12. Both events begin at 2:00 p.m. Eastern.
The webinar will educate probation officers, case managers, treatment providers, and others working in treatment courts on the fundamentals of Core Correctional Practices (CCP). The skills developed through CCP are designed to improve team members’ relationship skills, rapport, motivational enhancement strategies, and cognitive-behavioral problem solving approaches critical to aligning with national best practice standards. While developing these skills among case managers is critical, all team members are encouraged to attend to learn how the skills can be used in various roles in the treatment court.
The one-hour webinar includes an brief overview of the research on CCP, the three main components of CCP (relationship building, motivational enhancement skills, and intervention skills), an example demonstration of one skill within each component and Q&A.
The post Webinar: Improving Client Outcomes: Using Core Correctional Practices in Treatment Courts appeared first on NADCP.org.
photo credit: hobvias sudoneighm
From Reconsidering the Usefulness of Adding Naloxone to Buprenorphine:
If information circulating in the recreational drug-using community is in reality more accurate than the information coming from the medical community, it can only be a matter of time before that hard-won trust is eroded.
Blazes, C.K., & Morrow, J. (2020). Reconsidering the Usefulness of Adding Naloxone to Buprenorphine. Frontiers in Psychiatry.
- You’re not feeling well.
- You want to get ahead of traffic.
- You need to get the kids home because … (You can basically fill in the blank here).
- You have a ton of laundry to do.
- You want to go home.
- You have to go binge-watch Orange Is The New Black on Netflix.
- You don’t owe anyone an explanation. You’re a grown-ass-adult, and you’re free to do whatever you want. BOOM.
5. Make plans to meet up with friends after.
If you’re not feeling 100% confident, but can’t get out of it, it’s always a great idea to have plans after. This provides you with good reason to leave early if you need to, but also may help you avoid drinking or use – even if you really want to—because you’re accountable to those friends, and you know they’ll miss you if you don’t show up.
6. Have your friends on speed-dial, and don’t be afraid to lock yourself in the bathroom.
Calling people you trust with your recovery is never a bad idea regardless of what day it is. During holidays though, I find it’s much easier to ensure contact with people when I give them a heads up that I may be calling in a crisis situation. This gives them the opportunity to tell me that they actually won’t be available, so I can find someone else, or invites them to keep their cell near by.
7. Be kind to you.
Look, I know family time can be difficult—even under the greatest and most supportive circumstances – and even after years into recovery. It’s okay. Please know you’re okay and that there’s nothing wrong with you for not wanting to sit around a very large table and be interrogated by people you maybe haven’t seen since last year. It’s okay if you don’t want to share, even the great things that have been going on, with those in your life that might remember when things weren’t as awesome. It does not make you a bad person to take a time out and care for yourself.
8. Keep in mind recovery is a daily process
My personal recovery is a part of me I have to nurture daily. Some days I need to pay more attention to it than others. It’s kind of like having a cat. When I’m showing it constant attention, it may appear not to need me. The more I ignore it or pretend it’s insignificant to my daily life, the more vulnerable and needy it might get.
Be aware of your triggers, and the patterns of your past. If every Thanksgiving you do the exact same thing and it lands you in a position you don’t want to be in this year, change the plan.
Even if it’s not a perfect plan, I promise it will allow you one step further to where you want to be in your recovery—whatever that looks like.
9. Be prepared to forgive yourself if you don’t have a great day.
No one is perfect, and no plan can be 100% fool-proof; especially when family is involved. If you say or do something you regret, it is possible the sun will rise the following day allowing you the opportunity for progress. Did I mention holidays are hard? Good. Please be gentle with you.
10. Do the best you can with the tools you have
At the beginning and end of each day, all we have we have is our best. Today’s best might look different from yesterday’s, and tomorrow’s best might be even more promising than today’s. Try to be patient with yourself and allow yourself the opportunity and grace to make mistakes and learn from them. You’re awesome.
And if the next day you feel you made the wrong Thanksgiving decision, rest assured, there will be another one coming around the corner before you know it.
Julie Maida has been in abstinence-based recovery since May 2, 2000. She is fiercely determined to advocate for and connect ALL women with the appropriate support and resources necessary to achieve their personal recovery goals. She writes about mothering with mental illness at juliemaida.me.
Gabapentin can be addictive. Search for gabapentin or pregabalin abuse on Google Scholar and you’ll turn up more than 26,000 results in a fraction of a second. Pubmed is a little more specific, finding 420 papers on the subject. Vaults of Erowid has hundreds of gabapentin and pregabalin experiences detailed by users. It seems gabapentinoids are making a splash, but who’s getting wet?
A few years ago, I wondered if it were becoming almost mandatory for clients coming to addiction treatment to be on opioids and gabapentin for pain despite experts warning that opioids and gabapentin are best avoided in those with a history of addiction. In Scotland’s horrific drug death figures from 2018, the gabapentinoids were implicated in a third of deaths. Gabapentin prescribing does seem to be a growth industry.
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The rate of patients newly treated with gabapentinoids has tripled from 2007 to 2017 in primary care in the United Kingdom. By 2017, 50% of gabapentinoid prescriptions were for an off-label indication and 20% had a coprescription for opioids
JAMA, 2018
How do they work?
Gabapentin and its more expensive, faster-acting cousin pregabalin, act on nerve cells to reduce release of ‘excitatory’ neurotransmitters. Used in epilepsy, they ‘soothe’ the nervous system. They also may have a direct or indirect effect on the dopamine reward/salience/motivation system. That’s the same pathway that most addictive drugs end up stimulating. These drugs can certainly induce euphoria and relaxation, especially at higher than prescribed doses.
Side effects are high (69% of people taking pregabalin). Withdrawal effects are well recognised and can include insomnia, anxiety, pain, depression, sweating and fits. If these drugs are to be discontinued, this should be done gradually with monitoring.
Gabapentin has clear therapeutic impact on seizure activity and evidence of an impact for some people on two types of neuropathic pain, but these potential benefits need to be balanced against the risks in addicted populations. In my experience, many patients seem to be on off-label prescriptions.
There are reports of these drugs being used to maximise the effects of methadone and being misused by heroin users.
Unfortunately, our clinical experience suggests that gabapentin is now prevalent as a drug of abuse… In primary care, an increasing number and urgency of prescription requests cannot necessarily be explained by the increased number of cases of neuropathic pain.
British Journal of General Practice, 2012
Rising evidence of harm caused the reclassification of both gabapentin and pregabalin to class C by the UK Home Office in 2019 in the hope that prescribing, and associated harms, would drop, but an article in the British Medical Journal earlier this year reported no change in gabapentinoid prescribing habits. One of the issues is the relationship between deprivation, pain and prescribing.
One expert quoted in the BMJ said:
The high numbers are a reflection of the limits of what GPs can do when they are seeing patients with no hope or capacity to change their situation. There are very few alternatives for pain that do not carry risks. What do you do when you’re faced with someone who is in pain and has very little hope or social support? GPs are stuck in the middle.
Offer referral to appropriate treatment and support perhaps? But the article goes on:
Addiction services have seen heavy cuts across England. In 2018, the BBC found that budgets for treatment services fell by 18% between 2013-14 and 2017-18, which contributed to a 26% rise in drug related deaths between 2013 and 2016.
And what of more specific treatments – say rehab?
Meanwhile, the Care Quality Commission estimates that the number of live-in drug and alcohol rehabilitation services in England has fallen from 195 in 2013 to 132 in 2019.
“The solution is not complicated,” said [Ian] Hamilton [a senior lecturer at the University of York]. “We need more support services and for drug treatment to be invested in. People are paying with their lives.”
Association between cell density at baseline (measured by restriction spectrum imaging) and change in waist circumference one year later. Cellularity in the ventral striatum demonstrates the strongest relationship among all regions in the subcortex
Differences in the microstructure of the nucleus accumbens (NAcc), a region in the brain that plays an important role in processing food and other reward stimuli, predict increases in indicators of obesity in children, according to a study funded by the National Institute on Drug Abuse (NIDA) and nine other institutes, all part of the National Institutes of Health. The paper, published today in the journal Proceedings of the National Academy of Sciences, is based on data from the Adolescent Brain Cognitive Development (ABCD)SM Study. The ABCD Study® will follow nearly 12,000 children through early adulthood to assess factors that influence individual brain development and other health outcomes.
Findings from this study provide the first evidence of microstructural brain differences that are linked to waist circumference and body mass index (BMI) in children. These microstructural differences in cell density could be indicative of inflammatory processes triggered by a diet rich in high fat foods.
“We know that childhood obesity is a key predictor of adult obesity and other poor health outcomes later in life,” said Nora D. Volkow, M.D., director of NIDA. “These results extend previous animal studies to reveal what may prove to be a vicious cycle in which diet-related inflammation in brain striatal regions promotes further unhealthy eating behaviors and weight gain.”
Evidence from past human imaging studies has demonstrated the relationship between the NAcc and unhealthy eating behavior in adults. In this study, the researchers leveraged new diffusion MRI imaging techniques to examine the cellular structure of areas that comprise the striatal reward pathway in the brain to investigate disproportionate weight gain in youth.
This study included data from 5,366 ABCD Study participants, ages 9- to 10-years-old at baseline, of whom 2,133 returned for a one-year follow-up visit. The mean waist circumference of the participants, used here as a measure of body fat, increased an average of 2.76 centimeters per participant from the baseline through the one-year follow-up. The researchers used a noninvasive MRI technique to show that an alleged marker of cellular density in the NAcc reflected differences in waist circumference at baseline and predicted increased waist circumference at one-year follow-up.
Because the ABCD Study is longitudinal, it will allow to assess if this association holds or changes over the course of adolescent development, and what factors may influence this trajectory.
Obesity in the United States affects approximately 35% of children and adolescents and is associated with negative health consequences, mentally and physically, as well as higher mortality rates. Children who are obese have more than a fivefold likelihood of becoming obese as adults. Predictive models of weight gain in youth, coupled with knowledge about factors that could impact this trajectory, would benefit public health and individual wellbeing.
Reference:
Rapuano, KM; Laurent, JS; Hagler, Jr. DJ; Hatton, SN; Thompson, WK; Jernigan, TL; Dale, AM; Casey, BJ; Watts, R. Nucleus accumbens cytoarchitecture predicts weight gain in children. PNAS. October 12, 2020.
I have been a student of the field for well over three decades. I have operated an outpatient and a residential program treatment program and in recent years ran our statewide recovery community organization here in Pennsylvania. My work has led me to be very engaged with policy matters, with care system workforce being a major area of focus. It is my sense that substance use is our leading public health crisis beyond COVID-19 and that greater focus on substance use and long term recovery can save lives, communities and resources. Increasingly, my sense is that our SUD workforce and our entire care system is in an exceptionally precious position. In my opinion, failure to pay attention to our growing SUD workforce crisis will be disastrous.
In many respects, our care system workforce crisis is not new. The challenges we faced twenty years ago remain, and we have new ones too. An aging workforce that is underpaid, overworked, saddled with massive administrative burden working in an acute care system. An ever-increasing amount of their time is spent trying to get fewer and fewer units of services. Compensation in inflation adjusted dollars was higher when I started my career than they are now. Care providers have a smaller pie with an ever-increasing amount of non-direct care requirements.
The people who do this work do it because they care deeply about the outcome – getting people into recovery and helping them sustaining it over the long term. My organization, PRO-A, the statewide recovery community organization for Pennsylvania did an SUD Workforce survey for our the Pennsylvania Department of Drug and Alcohol Programs a number of years ago. The overall sentiment was that people were leaving our workforce because they were able to spend less and less time doing the actual work of helping people. Without that, they had no reason to stick it out. They are the heart and soul of our SUD care system workforce and the are leaving in droves even as we make it harder to get into the workforce.
Since then, we have submitted several reports to our state, including a 2019 report titled Thriving Communities in Recovery: Policy Report on National Trends, Best Practices, and Evaluation of How Pennsylvania Can Improve its Recovery Environment that focuses on retooling care towards a long term support model and in 2020 a report on our state SUD peer workforce challenges and opportunities. What I have learned though my focus on our SUD care system workforce is that there are people who do this work despite the difficult challenges and overwhelming barriers that make this work very challenging.
The core of our entire SUD service system from my perspective is the recovery community and family members with lived experience. They get up every day and do the work because these are “their people.” They do it because at some point in their own histories someone was there for them when they needed. They do it to pay it forward. They do it to save lives and help others into recovery because it is a mission that they believe in. They do it despite all the challenges. They do it because few others will.
But my sense is that it is getting increasingly harder for them to do. As I noted in my PA State House Human Services Committee testimony a few weeks back on the impact of COVID-19 on our care system, staff are risking their lives and sometimes dying as a result of their jobs and COVID-19. Programs are saddled with extra expenses because of the virus and plummeting censuses. Seasoned staff who have long had their fingers stuck in the holes of our service system levees are getting very tired. Relapses are increasing, substance use and overdoses are dramatically increasing. I talk with a lot of people doing this work across the nation and truth be told I hear exhaustion in their voices. I see veteran staff leaving for other work or retiring in increasing numbers.
It has been said that every crisis presents opportunity. What we have right now are multiple crises converging and a diminishing window of opportunity. We have an addiction epidemic that has been picking up steam in recent years, an SUD care system workforce crisis that has been simmering on the back burner for decades. The black swan COVID-19 crisis has put health disparities and care system challenges in stark relief. Addiction is a central element in many of our societal challenges. Our very fragile SUD care system is beginning to fall apart, and much like a stream bank undercut by flowing water much of what is happening is not visible to those standing on the sidelines.
If there was ever a time to retool our care system and focus on workforce development, it is right now. Every indication is that we are going to need a reinvigorated care system and a strong workforce. My observation is that we never actually get to focus on workforce challenges because there is always some other more acute, pressing issue. The time is now, the opportunities abound, but every moment we delay, our workforce challenges become a bit more challenging and harder to address.
So what should we do? For one, we need to recruit and develop more people in recovery to do this work over the long term. We need to remove as many bureaucratic burdens as we can and allow people the time to focus on the core of the work – assisting people with their treatment and recovery. We should move our care system towards long term recovery orientation while addressing system shortfalls. If there was a convenient time to focus on these challenges, we would have already done it. In the absence of an ideal time and in recognition of our decaying workforce and the nature of the crisis we are in, I would humbly suggest that right now is the time to reimagine our workforce and begin to build out a workforce to meet the challenges ahead.
What do you think?
Who are you?
My name is Andre Johnson. I’m a person in long-term recovery. And what that means is, I have not used drugs or alcohol in over 32 years. My sobriety date is July 13th, 1988. I am a tax-paying citizen and very intentional about my recovery and helping others. If it was not for recovery, I wouldn’t be able to be a productive member of society, I would not be able to be an active, present father to my 22-year-old daughter, and I certainly wouldn’t be able to be a husband to my wife. And by the way, we are newlyweds, we got married July 27, 2020.
What do you do professionally?
Professionally, I’m the president, chief executive officer of the Detroit Recovery Project (DRP), an organization that I founded the year of 2001. We are a peer-led, peer-ran and peer-driven organization that operates in the city of Detroit. We have two large recovery centers, one on the east side, and one on the west side of Detroit, that are created and designed to help people sustain long term recovery, and also provide recovery support services, meeting clients wherever they are. It’s a client-centered approach–we meet the clients where they are. And people come to us in many different phases. Some people come to us interested in obtaining employment, obtaining a higher education, or reintegrating back with their families, reintegrating back with their loved ones, seeking out a supportive network of people in recovery that share the lived experience or just the need for tools to help them to stay drug and alcohol-free, including staying criminal free. And so these settings and environments were created and developed by individuals that are in long-term recovery……predominantly recovery-ran, recovery-oriented, to really meet the needs of people to change the trajectory of their lives.
You’ve been with DRP since 2001, tell us more about your professional experience in the area of addiction
My recovery road has been extremely interesting. When I first got drug-free in 1988, I actually ended up becoming employed with SHAR House. It’s a residential program where I was once a patient. Shortly after getting clean there, I realized that I wanted to work in the field of addiction. I was really, really struck by the therapists who really empowered not only me, but empowered many other people to want to live a drug and alcohol-free lifestyle. I guess, in a way, I was baptized professionally… when you look at my colorful past. I realized early on that I didn’t wanna do any other work. This was the work that I was interested in. This was the work that made my heartbeat. This was the work that I found my purpose and meaning in life. And, I would like to think that I even got good at it, and learned a lot professionally from my late mentor the Executive Director Mr. Alan Bray.
So I worked at SHAR House as a monitor. Back in the late ’80s, you can take a state exam, there was a state exam called Fundamentals of Alcohol Drug Abuse Program (FAODP) and when you pass that test, you feel like you just completed a doctoral degree! But I remember getting that certificate and learning more about the academic perspective of addiction. Enabling me to integrate my personal experience and education to being a well rounded professional.
Later, after six years of sobriety I ended up going to college. I did attend Wayne County Community College. I got clean, at 18. It was unprecedented at that time. I was the youngest person in a rehab that housed close to 200 people. Everybody looked at me as their kid, their nephew, or their son. The average age of people in treatment at the time was 40 years old. So I was able to be around a lot of people who had a lot of experiences. I like to say, I had a lot of wisdom poured upon me from the participants who were in the program, but also my therapists.
Let me back up, prior to entering SHAR House, I was in a program called Hegira Alcohol Drug Treatment Center in Westland, Michigan. This program was based out of the old Eloise psychiatric hospital Detroit, I was in that program for two weeks. My probation officer personally transported me to that program. I had entered in his office on a Monday, just a day like this, a nice sunny day in July, and I was coming off a really, really tough bad weekend, and I had been a fugitive from the facility that I was in. And my addiction had basically helped me to see that I needed help. I hit a rock bottom at 18. And I remember entering his office and saying, ” Mr. Hooks I need help,” and I just started crying. I said, “I need help bad.” And I remember that Friday before that Monday I had walked like five miles in Detroit distressed and depressed contemplating suicide.
I just cried out, “God, I need help.” Most people in recovery can relate to you just saying, “God, I need help.” And so I had got help. He personally transported me to the drug treatment center. And I had a woman who was my therapist, her name was Wanda. She was a White woman, five foot… Five feet flat. And I’m this Inner City Black kid and I’m like, “What is this?” In some communities, Blacks were taught, “Don’t trust white folks.” But if you hit the bottom hard enough, you don’t give a damn about the color of nobody’s skin. In fact, when you hit that bottom, you can even become very color blind. But this woman, this counselor, this therapist, her compassion, empathy, and genuineness inspired hope in me, she empowered me during those two weeks so much where once I got done after those two weeks, I felt like she was my Yoda and I was Luke Skywalker. The force was with me!
I spent 14 days detoxing and getting individual therapy. That was really when I can say that my recovery pivoted. She encouraged me to enter long-term treatment, and so I spent 120 days in SHAR House. That kind of time is not even heard of now a days. After spending 120 days, completing treatment on December 8, 1988, I immediately entered into a program called the Aftercare on the westside of Detroit on Maybury Grand where I resided for two years. During those two years, I was really exposed to the field. I got hired as a staff monitor, and years later after passing my FAODP, I ended up becoming a counselor for SHAR House. I eventually worked for Wolverine Human Services, and Hudson Adult Care Home.
I realized at that point, a couple of years later, I needed to pursue higher education if I was gonna really be able to grow and really challenge myself. So I was able to go to Wayne County Community College, and then I eventually transferred to a historically Black college in Atlanta, Georgia, Morehouse College, and obtained my degree in Psychology. At that time, I graduated in 1998, I remember it like it was yesterday… I had 10 years, I had a decade of recovery and sobriety, and I was feeling like I was on top of the world, and I realized that I needed to continue my education further, so I eventually got my Master’s degree.
Once I returned from Morehouse in Atlanta, I got hired for an organization called Neighborhood Service Organization. I worked there for one year and then I got hired at the Detroit Health Department and worked under the leadership of Dr. Calvin Trent, who was in charge of the City of Detroit Bureau of Substance Abuse Prevention Treatment and Recovery. That’s when I really began to understand some of the inner workings of the business from an administrative perspective, learning about block grant, learning about Medicaid dollars, and how dollars were allocated. I would sit on committees that allocated $35 million throughout the City of Detroit provider network. I also had a responsibility to act as a project manager, and my job was to audit all the treatment programs in Detroit. I conducted financial audits and programmatic audits, so that gave me a lot of insight to the business side of the addiction field.
Then that got somewhat boring, just ’cause I was really pushing a lot of paperwork. So, Dr. Trent said, “Hey, Andre, I would like for you to be the Director of The Partnership for A Drug-Free Detroit Coalition.” That was a very large, very influential, coalition that was founded by the Detroit City councilwoman, Alberta Tinsley-Talabi. In that coalition, we had a faith-based component, we had a recovery component, which was my responsibility to build from scratch. In fact, Dr. Trent even said, “Hey, Andre, here is $100,000, start-up money. And I want you to create a recovery program.” And so just having all those experiences kind of morphed into what we know today as the Detroit Recovery Project, which obviously we grew, we evolved, we’re still growing. And I would like to say, we’re making a difference in the City of Detroit. The late Dr. Calvin Trent mentored me and was life a father that I never had may his Rest In Peace!
Professionally, what are you most proud of?
I’m excited about a lot of stuff. One is, I was fortunate to receive an award from President Barack Obama called the “Champion of Change” Award during his last days in the office. I received an award from our national advocacy organization Faces and Voices of Recovery, the “Vernon Johnson Award”. I would say we don’t do our work for recognition but be recognizing from peers across the country has definitely inspired me to continue the work. But professionally, I am humbled and honored to be able to say that I created a impactful organization that has touched the lives of thousands throughout metro Detroit and now employs over 50 employees.
I’m proud of the creation and development of that organization, also being instrumental in making sure that recovery support services are now a billable service in the State of Michigan. 20 years ago, it was not a billable service. And so our organization was very instrumental in partnering with the state of Michigan garnering the support of Ms. Deborah Hollis and Mr. Larry Scott’s [Director of Michigan’s Office of Recovery Oriented Systems of Care]. And they really listen. We partnered with Wayne County. We’ve partnered with all the governmental funding agencies to be able to bill for recovery support services. That’s a big thing in our whole state, as I’m sure you would know.
Now we’re able to now sustain a new innovative approach, through lived experience. I mean lived experience has a lot of value. The powers that be recognize that lived experience does have value, and it was important to support financially.
What keeps you working in this field?
The thing that keeps me are the people. When you see people who come to you at rock bottom, trying to figure out what’s the next step, and you see them one, two, three, four, or five years later, and they’re married and they have beautiful relationships with their children, they are homeowners, they have positive career track records, and they are staying sober. So being an active member of the 12-step program, we have a saying, and that saying is, “We can only keep what we have by giving it away.” [chuckle] So that’s one of the things that motivates me. My predecessors, the mentors I’ve had in my life, these were men and women, who were very, very passionate, compassionate people, that understood the importance of working in an inner city like Detroit, where we kind of see the downtrodden, where we see the person at a bottom… that hit a bottom, below the bottom, and to see those people succumb to the obstacles. We see and help individuals tap into their inner resiliency. Witnessing people who have overcome trauma, the hardships in life. And to see people living a drug-free, criminal-free, productive lifestyle is what motivates me to want to continue to work in this field. I can never see enough of that.
Knowing that I was once on the other side of the tracks, and not only that, knowing that I’ve lost family members to drug addiction. When I think about my mother, Sandra Johnson, who died of an overdose on 9/11/2004, of an oxycontin overdose. We’re talking about a registered nurse by trade. She retired from the Michigan Department of Corrections, but prior to her retirement, she was involved in a serious auto accident, which resulted in a very serious leg injury. That leg injury resulted in her abusing oxycontin–we’re talking about a woman who never used any drugs or alcohol when I grew up.
So, to see and to live through that, I realized and recognized the importance of having people like you and me, who have some “skin” in the game, and have some experience and knowledge. I think this field is continuously growing and continuously evolving. And, I think it’s important that somebody like me continues to stay engaged and be up for the challenges, so that we can continue to have influence and to create programs that are more meaningful and not necessarily focused on the financial aspect, but focusing on the quality of life for people we’re serving.
How has the pandemic affected your work?
The pandemic has affected DRP in a major way. We’ve certainly had our share of losing friends of DRP, staff of DRP, and those lives are gone.
We miss the voices, it’s a grief and a loss experience that I think me and many of our staff have experienced or are experiencing. And again being in an Inner City, we have a saying, “When the state of Michigan gets a cold, Detroit it’s gets the “flu”.
It’s really bad. Relapse rates have increased because of the pandemic and then as you know, recovery, the whole recovery model is built on a social support system. It’s built on embracing each other. It’s built on hugging each other. It’s built on loving each other. That’s all BC (Before COVID). Now everything has changed. Now we’re encouraged to wear masks and keep six feet distance from individuals. We’re encouraged to provide services via telehealth. This is non-contact approach. And telehealth services is a benefit, the fact that we are able to access it. But I do think that the ability to really make the connections, the face-to-face connections that we have historically made with our clients, we have seen a client reduction in our organization.
But COVID is still alive and free in our community. We’re continuing to be progressive, adhere to the precautions that come along with Covid-19, and we’re ready to fight the fight. We’re ready to instill recovery and instill a new lifestyle for people who are suffering from Covid-19 or helping people who are at risk do the right thing.
What are the biggest effects you see of the pandemic on the people you serve?
So a couple of things. One is anxiety, depression, and something known as complex post-traumatic stress disorder. A lot of folks are lonely, and again, the whole recovery model has been built on having a camaraderie. Being able to go to 12-step meetings and then go out and eat lunch dinner or breakfast. Those individuals typically become your extended recovery family members, and so people who are not able to engage in those recovery-oriented activities find themselves lonely. My last count of the number of people who died in the recovery community in Detroit was 33 people. And, we’re talking about people who we were not able to grieve properly. With the funerals having no more than 5-10 people at a time, we’re not even being able to attend people’s funerals. There’s a lot going on that does have a lot of impact. And so when you have anxiety, you have depression, a lot of it is based on fear. And when you have these fears, I think as a society, whether you’re in recovery or not, people are looking to escape those feelings and those emotions. We know recovery is about embracing and leaning into those fears and embracing those emotions, because those are the very components that allow us to grow and flourish.
So we have to be able to, what I would say, find the silver lining in all of this. And sometimes it’s finding ourselves. And so if we’re finding ourselves alone, that’s an opportunity to grow. Some people look at it as a negative thing. It can have some negative consequences if you do not take action, if you don’t have someone to help you to process it. I was on the phone with a guy earlier who was crying like a baby, and he was just experiencing all this fear–the fear was stemming from whe was seven years old, he’s in school, he’s married, he just closed on a new home and life is going good. But again, I think fear is a scary place. But one of the things I learned early in recovery is it’s about having healthy fear. For me, you wanna have a healthy fear about using drugs. You wanna have a healthy fear about selling drugs. And you take that energy and you flip it in doing into something positive and concrete for yourself. And that’s when you begin to grow. Recovery is about growing, expanding, and tapping into our inner self so that we can be the best person that we can be. Tapping into our inner creativity because fear, anxiety and depression is a self-destructive path … They are all distractions. They are distractions that will take us from being the best us.
What long-term effects do you see on the field following the pandemic?
I think we’ll probably have an increasing number of telehealth services, which I’m sure we’ve already seen… I heard Zoom’s stock went up, not that I’m trying to promote Zoom, but I’m sure they’ve certainly benefited from the pandemic because of telehealth, because of the way business is now being done. Most business, as we know it, is being done via Zoom.
So I’m thinking that it’s gonna be an opportunity for us to develop and create some more innovative recovery programs to help people during this pandemic. I don’t think it’s realistic to anticipate this pandemic being over in four months. The last article I read from the Center for Disease Control indicated that we can expect some vaccinations towards the end of ’21. So that means we know we have a whole another year around this.
I think we have been creative and innovative in terms of creating support groups on Zoom. Obviously, this is innovative, and I’m very thankful that you invited me to be a part of your recovery blog because we have to get the communication out. We gotta continue to make sure that these stories are available in our communities, and we just gotta keep working together.
How are services going to have to change in response to the pandemic?
I think the only real alternative at this point is telehealth services, and developing technically savvy tools to reach the hard to reach population but I do think we have to be more creative in engaging people in some therapeutic approaches that can help them find hope in their spaces. Some of the challenges in Detroit, is some people don’t have computer literacy skills, in fact a lot of people don’t. And then a lot of people don’t have a computer, and in some cases, they don’t have internet access. So I think as this disease or this COVID-19 continues to grow, I think it’s gonna get worse for the people who are less fortunate. It’s gonna have a more dire impact on the vulnerable and disenfranchised communities, because they don’t have the access that other communities have.
If you were able to devote yourself to a fantasy project to improve treatment and recovery support, what would it be?
I would have a one-stop shop that would encompass treatment, phase one, phase two, recovery support services, and it would be a more integrated approach where we would have residential treatment, we would have outpatient treatment and then people can transition from residential treatment to recovery housing and then they can transition from residential treatment to outpatient therapy. And then while they receive an outpatient therapy, there would be an integrated approach with recovery support services. Everybody would have an outpatient therapist and they would also be assigned a recovery coach. And that program would be at least a one to two-year commitment.
If we’re gonna really make a difference and make a change in people’s lives, we have to have realistic and measureable programs that are more long-term oriented. In 28 days, you just scratched the surface. And again, working with the population in Detroit where you have people who don’t have employability skills, transportation, legal issues… all that has to be resolved and worked out, and it often takes three to four years just to find some freedom in those areas.
Probably 70% to 80% of the people we serve are men. A lot of these men have child support issues where they may owe Wayne County Third Circuit Court somewhere between $50,000 to $100,000 in child support. Not to mention their credit–FICO scores average 400 to 500 and don’t really have an understanding of what credit is. And then we’re talking about bank accounts… there’s a lot of work that needs to be done.
Another component that would be vital for me would be to make sure we have an integrated physical health component. Because now, I say people are not only not dying by the drugs, but they’re dying by the fork! A lot of people have “COVID-19 weight” now because they are emotionally eating. And so we’re gonna see an increase in comorbidity, people who have diabetes, high blood pressure, high cholesterol, etc. The healthcare system is swamped and saturated right now, so people are not getting their regular health screening, men are not getting their prostate exam, females are not getting their mammograms.
And so I would like to see a more holistic approach that helps people. So when you enter into this office, I would have a TV monitor that talks about a holistic recovery program, describing your physical health, your health and wellness and describe what you’re gonna do to retain and sustain your long-term recovery, so that you can reduce your chances of relapse. So I have a full-fledged fantasy agency in my head!
This article, Many Residential Addiction Tx Centers Don’t Offer MAT, at a Deadly Cost, has some serious flaws but it addresses an important and common gap in systems of care.
What it gets wrong
The flaws relate to it being a mish mash of criticism of non-agonist treatments.
First, the article seems to be muddying distinctions between residential treatment and recovery housing. The patient discussed seemed to be in a residential program that allowed agonists, but discontinued because there were no recovery homes that allowed opioid agonists.
Second, it represents residential treatment as something akin to a Pentecostal cult. Spirituality is commonly found in treatment, but requiring begging for forgiveness and administratively discharging people for atheism are far outside accepted practice.
Third, the author says 12 step approaches are not backed by research and strangely links to the flawed and misunderstood 2008 Cochrane review rather than the new 2020 Cochrane review, which concluded:
There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non-manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non-manualized, may be at least as effective as other treatments for other alcohol-related outcomes. AA/TSF probably produces substantial health care cost savings among people with alcohol use disorder.
Alcoholics Anonymous and other 12-step programs for alcohol use disorder (Review)
Fourth, it raises concerns about health professional recovery programs without mentioning that they happen to have really good outcomes.
What it gets right
The article explores some of the barriers to integration of agonists into residential, housing, and health professional monitoring programs. The article closes with this:
“People with substance use disorder need access to this medication, maybe for short-term, maybe for long-term, or maybe for the rest of their lives,” Hornak said. “They should not be discriminated against.”
Let’s set aside my belief that articles like this often overstate the effectiveness of agonist treatments.
The issue that this article gets right is that these patients deserve better access to the full range of recovery support services.
Access to residential that allows agonists is limited and probably non-existent in a lot of regions.
Worse, access to recovery housing is also too limited for patients on agonists. This issue of access to housing was central to the tragedy the article opens with.
What it overlooks
The article overlooks a couple of important things.
First, there are good reasons for wanting an agonist-free treatment/recovery environment.
Acknowledging that agonist-free treatment/recovery environments are important does should not be construed as suggesting that agonist-inclusive environments are not important.
Second, the article doesn’t seem to pause to contemplate who is responsible for these patients and meeting their needs. The insertion of discrimination places moral responsibility on non-agonist programs. However, given my first point, maybe we should question that assumption.
It is very frustrating that it can be so difficult to find programs that meet the needs of these patients, and it’s natural to direct that frustration at programs that exclude them. Indeed, any program that claims to care deeply about people with addiction is obliged to make meaningful efforts to meet the needs of these patients, particularly as their numbers grow and the overdose crisis persists.
All this is true, AND that headline could just have easily read “Many MAT Programs Don’t Offer Recovery Housing, at a Deadly Cost.“
It’s worth stopping and asking where existing recovery homes came from. In my region, many of these homes were started by recovering people who wanted to help people along the pathway that made their recovery possible.
The other recovery home operators are treatment programs. At Dawn Farm (I no longer work there), we opened our first house in 1998 because we knew many of the people we saw in our social detox program didn’t need residential treatment but also needed more support than outpatient treatment could offer. We soon realized that this service could shorten residential stays, improve outcomes, and extend the duration of recovery support.
We didn’t want to get into the housing business. We saw it as outside of our scope of services and it demanded skills and knowledge we didn’t possess at the time. We thought someone else should do it, like a housing program, but it was also clear that no one else was going to develop a program around our client’s specific needs. Our model didn’t make money and was a lot of work. (Though it did cover its costs.) We did it in pursuit of our mission to help people with addiction achieve long term recovery.
It would be a very good thing to see MAT providers (and advocates) similarly work toward developing a broader continuum of recovery support services to meet the needs of their patients. (I write this as the director of a program that provides MAT and needs to do better at developing systems of community-based long-term recovery support.)
Peter Finger is a SMART Recovery Regional Coordinator in Sioux Falls, South Dakota. He is also an advocate for the drug courts in his state.
In this podcast, Peter talks about:
Additional references:
Click here to find all of SMART Recovery’s podcasts
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We often expect those we serve to:
- be willing to make significant changes,
- sustain effort while making difficult changes that take time,
- and be willing to endure and benefit from practical lessons while making change.
But what about changes our organizations can make? Could some peer support of the organizational change process be helpful? Could some coaching tips in attempting system change toward a recovery orientation be useful?
This post will provide a partial overview of some aspects of organizational change, including contextual considerations, specific components of recovery orientation, the scale of change projects, and practical tips in making and supporting change. Examples of changes toward a recovery orientation will be included, along with citations for further study.
One contextual frame for the general guiding of organizational change is the notion of a helpful and effective “facilitating environment” (borrowed from Winnicott, 1974).
- For a clear picture of this, imagine an intentional ecological space within which there is effective nurturing and facilitation of personal development.
- Now make the relevant planning and related action for that support continuous down the following relevant layers, as outlined by Winnicott:
- the therapist and the laboratory (research efforts and findings),
- the therapist and their supervision (personal and professional development),
- the therapist and counseling (the context and provision of care),
- and finally, the patient and their home (as a system).
Changes consistent with Recovery Orientation can be made at the whole-organization level, entire programs can be modified, and specific practices within programs can be changed at the per-program level. Changes of this scale specific to Recovery Orientation have been achieved and written up for others to study (e.g. Boyle, M., Loveland, D. & George, S., 2010). In this type of planning, consider making changes that target either or both of:
- Disease Management (e.g. symptom suppression)
- Recovery Management (the pursuit of wellbeing).
Look for examples of change others have already made. Be sure to look for evaluation of their effectiveness, and for evaluation of the experience of those using the system. Nowadays, examples abound.
- Specific Disease Management efforts have been written up (e.g. Hamalainen, Zetterstom, et.al., 2018), as have patient experiences with disease management strategies (e.g. Nehlin, Carlsson, & Oster, 2017).
- Recovery Management efforts such as Recovery Coaching (White, 2004) have been archived, as have patient experiences with those kinds of strategies (Eddie, Hoffman, & Vilsaint, et. al., 2019).
Consider both the “New Paradigm” of Care and 5 Year Standard of Effectiveness.
- Practically speaking there is no such thing as “bad improvement”. In this way of thinking, virtually any starting point of change, and any amount of initial change is to be welcomed – both for the patient and for the system.
- Can we move toward that in our systems?
- In their article on a “New Paradigm for Long-Term Recovery” DuPont and Humphreys (2011) discuss the effect of: 1. services provided in the indigenous environment rather than a clinical setting, 2. a multi-year framework, 3. inclusion of person-centered goals, and 4. structured incentives that support positive change. These approaches have been found to be present in collegiate recovery programs, professional monitoring programs, and drug court models – probably going a long way toward identifying common factors for their shared effectiveness with disparate populations.
- Can we move toward that in our systems?
- Regardless of a person’s starting point, initial improvements, and incremental change, full-remission 5 years after the last clinical intervention is the standard for remission (when severe, chronic disease is the problem) and ultimate goal of comparison for eventual service effectiveness (DuPont, Compton, & McLellan, 2015).
- Can we move toward that in our systems?
Practical guidance in basic change principles for organizations and leaders to consider are also widely available. Some are general to any change effort, and some are specific to our work.
- General change related concepts and specific changes with practical relevance (increasing patient retention and decreasing wait times) have been archived for dissemination (e.g. McCarty, Gustafson, Wisdom, et. al., 2017). Practical axioms for leaders such as “When you think you’re going too slow, slow down” and “Don’t be afraid of change – you can always change back” can be very helpful in planning, guiding, and supporting change.
- Even multi-year, multi-program, organization-wide change efforts have been written up and evaluated (Loveland & Driscoll, 2014).
In reviewing these kinds of materials, you might find important changes consistent with Recovery Orientation can be innovated on a smaller scale as well. For example:
- Adding a technology solution blended with recovery coaching, both during and following residential treatment (Coon, 2013)
- Improving effectiveness at linking college-bound emerging adults with Collegiate Recovery Programs (Crowe, Hennen & Coon, 2017)
- Raising staff and student awareness of recovery support systems specific to undergraduate and graduate education, and that are available when later pursuing relevant professional licensure (Coon, 2015)
- Adopting a challenging best practice, such as transitioning to a tobacco-free treatment model (Coon, 2014; Martin, Lee, & Coon, 2018)
- Adding a coaching component and a technology tool for breath testing to an outpatient program (Hennen & Coon, 2020) to raise both retention and wellness.
Over the years, I’ve noticed it is helpful to have some support, encouragement, coaching, and guidance when attempting a change project, or moving a system toward a difficult goal. I have also noticed I’m in need of the same when coaching others in support of system improvement.
References
Boyle, M., Loveland, D., George, S. (2010). Implementing Recovery Management in a Treatment Organization. In Kelly, J & White, W. L. (Eds): Addiction Recovery Management: Theory, Research, and Practice. Pp. 235-258.
Coon, B. (2013). Center Uses Technology to Help Patients During and After Treatment. Addiction Professional. May 22, 2013.
Coon, B. (2015). Recovering Students Need Support As They Transition. Addiction Professional. 13(1): 22-26.
Coon, B. (2014). An Addiction Treatment Campus Goes Tobacco-Free: Lessons Learned. Addiction Professional. 12(1): 18-20.
Crowe, K., Hennen, B. & Coon, B. March 31, 2017. A Seamless Transition: Linking College-Bound Emerging Adults with Collegiate Recovery Programs. Recovery Campus Newsletter.
DuPont, R. L & Humphreys, K. (2011). A New Paradigm for Long-Term Recovery. Substance Abuse. 32(1):1-6.
DuPont, R. L., Compton, W. M. & McLellan, A. T. (2015). Five-Year Recovery: A New Standard for Assessing Effectiveness of Substance Use Disorder Treatment. Journal of Substance Abuse Treatment. 58:1-5. doi:10.1016/j.jsat.2015.06.024
Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., Weinstin, C. & Kelly, J.F. (2019). Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Frontiers in Psychology. 10:1052. doi:10.3389/fpsyg.2019.01052
Hamalainen M. D., Zetterstom, A., Winkvist, M., Soderquist, M., Karlberg, E., Ohagen, P., Andersson, K. & Nyberg, F. (2018). Real-time Monitoring Using a Breathalyzer-Based eHealth System Can Identify Lapse/Relapse Patterns in Alcohol Use Disorder Patients. Alcohol and Alcoholism. 53(4):368-375. doi:10.1093/alcalc/agy011
Hennen, B. & Coon, B. (2020). Recovery Coaching, Breathalyzer Boost Retention in Outpatient SUD Treatment. Addiction Professional. September 23, 2020.
Loveland, D. & Driscoll, H. (2014). Examining Attrition Rates at One Specialty Addiction Treatment Provider in the United States: A Case Study Using a Retrospective Chart Review. Substance Abuse, Treatment, Prevention and Policy. 9(41). doi.org/10.1186/1747-597X-9-41.
McCarty, D., Gustafson, D.H., Wisdom, J.P., Ford, J., Choi, D., Molfenter, T., Capoccia, V. & Cotter, F. (2017). The Network for the Improvement for Addiction Treatment (NIATx): Enhancing Access and Retention. Drug and Alcohol Dependence. 88(2-3):138-145.
Martin, L., Lee, J. L., & Coon, B. (2018). Implementing Tobacco-Free Policies in Residential Addiction Treatment Settings. Physician Health News. 25 (2): 14.
Nehlin, C., Carlsson, K, & Oster, C. (2017). Patients’ Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes. Journal of Addiction Medicine. 12(2):107-112. doi:10.1097/ADM.0000000000000373
White, W. (2004). Recovery Coaching: A Lost Function of Addiction Counseling? Counselor. 5(6), 20-22.
Winnicott, D. W. (1974). Fear of Breakdown. International Review of Psycho-Analysis. 1(1-2): 103-107.