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Recovery Housing and The National Drug Control Strategy. David K. Mineta Deputy Director, Demand Reduction Office of National Drug Control Policy (ONDCP). Presented at the 2014 NARR Annual Board & Affiliates Meeting St . Paul , MN June 7, 2014. A 21 st Century Drug Policy.

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Recovery Housing and The National Drug Control Strategy

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Recovery Housing andThe National Drug Control Strategy

David K. Mineta

Deputy Director, Demand Reduction

Office of National Drug Control Policy (ONDCP)

Presented at the 2014 NARR Annual Board & Affiliates Meeting

St. Paul, MN

June 7, 2014


A 21st Century Drug Policy

  • Stop drug use before it starts, and intervene early (prevention, early intervention)

  • Integrate with other sectors (primary care, campus health centers, etc.) using SBIRT

  • Expand access to treatment, including medication (buprenorphine, methadone, naltrexone)

  • Raise awareness of addiction and recovery

  • Expand access to recovery support services

  • Prevent & reverse overdose


Housing in the National Drug Control Strategy

  • Expand access to recovery support services, including recovery housing.

    • Profiles of promising Public Housing Authority reentry programs, many including recovery housing, are in development.

  • Eliminate barriers to recovery, including Federal policies, rules, and practices that impede access to recovery housing and other recovery support services.


The Need

  • In 2012, 22.2 million Americans aged 12 or older had a past year substance use disorder.1

  • Nearly 1 out 5 (18.9 percent) of young adults aged 18 to 25 had a past year substance use disorder.1

  • Long “addiction careers,” multiple episodes of treatment, and a median of nine years from first contact with public treatment system to one year of abstinence.2

  • Overdose epidemic: More than 38,000 drug overdose deaths in 2010, approximately 22,000 involving RX drugs (76 percent of RX overdoses from opioids).3

1 SAMHSA (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.

2 Dennis, M.L. et al. (2007). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment. 28 Suppl 1:S51-62.

3 CDC, National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database. Extracted May 1, 2012.


SAMHSA Recovery Framework

Recovery Housing Supports All Four SAMHSA Dimensions of Recovery

Dimensions of Recovery

1. Health: overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications … making informed, healthy choices.

2. Home: a stable place to live.

3. Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society.

4. Community: relationships and social networks that provide support, friendship, love, and hope.

Source of SAMHSA Dimensions: http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/


What We Know

  • Recovery housing (RH) produces positive outcomes:

    • Among residents of an RH linked with OP treatment, 68 percent were abstinent at 6 and 12 months, and 46 percent were abstinent at 18 months.1

    • An RH-only model achieved 40 percent at 6 months , 45 percent at 12 months, and 42 percent at 18 months.2

  • Research indicates that recovery housing can improve recovery outcomes:

    • Oxford House (OH) residence associated with abstinence from alcohol and drugs, improved employment and legal outcomes.3

    • OH residents who stayed 6 months or more had significantly better outcomes than those who did not.4

    • Recovery housing (RH) combined with RBT and RH alone produced significantly better outcomes than usual care among a sample of opioid dependent clients.5

1 Jason, L. et al. (2007). The need for substance abuse after-care: Longitudinal analysis of Oxford House. Addictive Behaviors. 32: 803-818.

2 Jason, L. et al. (2007). An examination of main and interactive effects of substance abuse recovery housing on multiple indicators of adjustment. Addiction. 2007 July ; 102(7): 1114–1121.

3 Tuten, M. et al. (2012). Abstinence-Contingent Recovery Housing and Reinforcement Based Treatment Following Opioid Detoxification. Addiction. 107(5): 973–982.

4 Policin, D.L. et al. (2010). What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here? Journal of Psychoactive Drugs. 42(4): 425–433.

5 Policin, D.L. et al. (2010). Sober Living Houses for Alcohol and Drug Dependence: 18-Month Outcomes. Journal of Substance Abuse Treatment. 38(4): 356-365.


What We Need to Know

  • What recovery housing (RH) models are currently in use?

  • What is the best way of classifying models for practical/clinical and research purposes?

  • What is the relative effectiveness of various RH models?

  • Can models be matched with populations?

  • What is the relative effectiveness and cost-effectiveness of RH offered in conjunction with various other services?

  • Is there a relationship between how RH is paid for and its effectiveness?

  • What our options for creating recovery housing in federally subsidized settings, such as public housing authorities.


Challenges

  • Developing local & municipal government partners, communities, and neighborhoods.

  • Standards:

    • Staffing, physical plant/safety (building code), siting/zoning, owner operator requirements

    • Cost/reimbursement

    • NIMBYism

  • Expanding partnerships with CJS, state and local substance abuse and mental health authorities, and segments of health care system.

  • Developing and evaluating public and private reimbursement mechanisms.

  • Leveraging Federal housing programs to expand capacity.

  • Integrating people in medication-assisted treatment.


Q & A / Discussion

David K. Mineta

Deputy Director, Demand Reduction

Office of National Drug Control Policy

dmineta@ondcp.eop.gov

WhiteHouse.gov/ONDCP


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