“Recovery Oriented Systems of Care” and “Recovery Management” are slowly becoming “Using-Oriented Systems of Care” and “Using Management”

May 20, 2023
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I assume the reader has heard the term “Recovery Oriented Systems of Care” and of the related clinical practices organized around what is called “Recovery Management.” Regardless, by way of review: 

  • ROSC was a specific macro-system inter-agency networking concept. 
  • RM was a micro-focused set of concepts and practices for services seated within and beneath ROSC. 

Lately I seem to notice a trend among addiction professionals and recovery advocates. What trend do I seem to notice? It seems to me that a significant portion of addiction professionals and advocates are tipping toward privileging using over abstinence. 

  • That is to say, there seems to be a trend toward making using the more sacred goal and the more hoped-for experience, over sobriety. 
  • And it seems I notice a move toward defining recovery in a way that includes using as the normal and central feature of recovery. 

It has been pointed out that historically, the primary mental health sector has had a strong partial recovery concept and a less robust full recovery concept, while the SUD sector has had a strong full recovery concept and less robust partial recovery concept.

While that is true, it is my opinion that for those with severe, chronic, and complex addiction illness, a framework centered in a goal of continuing using is fraught with peril.

I’ll go further and say that it seems to me that both the Recovery Advocacy Movement and the Recovery Orientation revolution for clinical services I personally witnessed spring up in the late 1990’s have now been shifted and repurposed by some into a: 

  • Using advocacy movement; and 
  • Using orientation for clinical services. 

Among other things, I seem to notice the four ingredients of Addiction, Treatment, Sobriety/Abstinence, and Recovery are now thought of by some as producing a kind of Using Violation Effect – whereby those four ingredients are considered to add harms.  

In this new world view I consider some additional concepts and practices. I’ve listed some below. 

  1. Using for the sake of recovery 
  2. Abstinence for the sake of using 
  3. Recovery for the sake of using 
  4. Abstinence is relieved by using 
  5. Abstinence for the sake of recovery is relieved by using
  6. Recovery is relieved by using
  7. Recovery for the sake of recovery is relieved by using 
  8. Recurrence of abstinence is a prequel of using
  9. Recurrence of use is relieved by using.
  10. Recurrence of recovery is relieved by using. 

A background in ROSC and RM 

The reader might ask, “What were ROSC and RM?” 

These concepts and related practices were largely birthed and developed within the Behavioral Health Recovery Management (BHRM) Project. That project was begun and operated across a 10 year period within my previous workplace (Fayette Companies/Human Service Center). I served on the steering committee of the BHRM project for the entire ten years of its existence (roughly 1997-2007). The BHRM project was operated across all of our agency’s programs, and we became a living laboratory. As a result of this effort, various concepts and practices were innovated and developed within our agency during the BHRM project. “Recovery Coaching” is one example; for those that are interested, here’s our original Recovery Coaching manual.

And concerning Recovery Coaching itself you might have noticed it has seemingly been replaced by “Peer Support”. And in some current versions of Harm Reduction, one Peer Support method is the Peer Support worker using with the peer they are supporting while the peer is using. 

What concerns me most in all of this is that it seems a Recovery Orientation for clinical services (study recovery and have those lessons inform treatment) is being replaced by a using orientation. That is, rather than adding an orientation and having an expanded menu of options, recovery orientation seems like it’s in danger of becoming obsolete. 

  • It seems like it’s been years since I’ve heard anyone even mention ROSC. 
  • It seems like managing using is becoming more popular in some clinical circles than managing recovery. 
  • It’s almost as if using with a good conscience is slowly becoming the sole marker of well-being. 

For those that would like more about original…

  • Recovery Orientation for clinical services;
  • Recovery Oriented Systems of Care as a service framework; or 
  • Recovery Management as a set of principles and practices for services;

…I can make a few reading recommendations. 

BHRM Statement of Principles This is a short read listing and describing the central BHRM concepts and practices.

Frontline Implementation of Recovery Management Principles This is a read of several pages. It’s an interview of our CEO who chaired our BHRM steering committee and includes the history and lessons learned inside our project.

Addiction Recovery Management: Theory, Research, and Practice. This is a book published by Springer. The two editors centered the book around Recovery Orientation, ROSC, and RM. The chapters are written by various authors from different backgrounds, settings, and service organizations.

Here are a few posts of my own that reflect my time in the BHRM project to a relatively greater degree than my other posts:

Planes, Car Repair Shops, and Dentists. This short read brings in lessons from outside the field.

Addiction and the Stages of Healing. This is a link to an entire series proposing a long-term research agenda and a unified model of thinking and clinical care.

The Four Pests: recovery, sobriety/abstinence, addiction illness, and treatment. Not a short read, but a relatively straightforward one noting some cautions from a project of the past outside of our field.

Recovery Orphans. Not a long read, but a challenging one. It consists of four separate short essays on the same topic. Each essay is a blend of philosophy and science. The essays become increasingly ambiguous and challenge the reader to reflect.

Study Betel Nut Before You Finalize Your Public Health or Harm Reduction Policy.

Peer Support, or Harm Reduction, or Recovery Coaching? This straightforward read presents a framework that blends these three practices within a Recovery Orientation perspective and a Recovery Oriented System of Care framework, while retaining Recovery Management purposes.

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