2016 NARR Conference October 18, 2016 Boston, Massachusetts

2. Fitting Recovery Residences into the Current Recovery Landscape Tom Hill Senior Advisor on Addiction and Recovery Substance Abuse and Mental Health Services Administration 2016 NARR Conference October 18, 2016 Boston, Massachusetts

3. There’s No Place Like Home

4. SAMHSA: A Public Health Agency within the U.S. Department of Health & Human Services • Mission: To reduce the impact of substance abuse and mental illness on America’s communities. • Vision: SAMHSA provides leadership and devotes its resources towards helping the nation act on the knowledge that: • Behavioral health is essential for health • Prevention works • Treatment is effective • People recover

5. #1- Prevention of Substance Abuse and Mental Illness #2 –Health Care and Health Systems Integration #3 –Trauma and Justice #4 –Recovery Support #5 –Health Information Technology #6 –Workforce Development SAMHSA’s 6 Strategic Initiatives

6. SAMHSA’s Working Definition of Recovery A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. (SAMHSA, 2011)

7. Four Dimensions of Recovery

8. BRSS TACS — Major Goals • Engage and promote leadership of people in recovery at all levels of State and local systems and services • Disseminate state-of-the-art information on recovery supports and services • Implement Recovery Support Action Plans for States, Territories, Tribes, and communities • Promote peer-driven, recovery-oriented systems of care

9. BRSS TACS: Key Activities • Policy Academies • Peer-Run Organization Subcontracts • Peer Health Reform Subcontracts • Webinars • Technical Assistance • First Fridays • Online Recovery Resource Library • Regional Summits

10. Technical Assistance • Expert Panels 3 virtual panels per year on topics related to behavioral health recovery • Webinars BRSS-TACS hosts 6 webinars per year • First Fridays A Brief Presentation and then discussion with experts on recovery topics

11. BRSS TACS Webpages You can find out about all BRSS TACS activities on the BRSS TACS webpages www.samhsa.gov/brss-tacs

12. Today’s Talk • Agenda • Setting the Context • Recovery Capital • Recovery-oriented Systems of Care • Current Events

13. Setting the Context

14. Addiction Recovery Advocacy Movement 2001 Recovery Summit in St. Paul • Official launch of Faces & Voices of Recovery The recovery movement: • includes people in recovery from addiction, families, and allies • includes and honors all pathways to recovery • encompasses all the diverse perspectives, cultures, and experiences of the recovery community

15. You’ve seen it, right? • A feature documentary film about the over 23 million Americans living in long-term recovery from addiction to alcohol and other drugs • Released in 2013 • Sparking a new conversation, following community-sponsored releases across the country • Now available on Netflix • http://manyfaces1voice.org/

16. Were You There? • UNITE to Face Addiction • Rally on the National Mall, Washington, DC • October 4, 2015 • http://www.facingaddiction.org/stories/

17. A Perfect Storm • Recovery-oriented Systems of Care (ROSC) • Affordable Care Act • MHPAEA • Managed Care Expansion • Recovery and Family Advocacy Movements • Peer Recovery Support Services • Criminal Justice & Drug Policy Reform Movements • Opioid Public Health Crisis

18. Recovery Capital

19. Many Pathways of Recovery • Mutual aid • Faith-based • Treatment-supported • “Natural” • Medication-assisted • Peer support services • Combination of any of the above

20. Continuum of Addiction Recovery Recovery Initiation & Stabilization Pre-Recovery Engagement Recovery Maintenance Long-term Recovery Adapted from William White Stages of Change/ Prochaska & DiClemente

21. Recovery Residences in the Continuum of Recovery Acute care (inpatient, medical, psychiatric) High Recovery residences: Enter at any level Level 4 Level 3 Service intensity Level 2 Level 1 Low Long-term recovery: Independent, meaningful living in the community Stabilization Recovery process duration

22. Recovery Capital In assisting people to achieve their recovery goals, it is often helpful to help them assess and build their Recovery Capital. Recovery Capital is the sum of the strengths and supports – both internal and external – that are available to a person to help them initiate and sustain long-term recovery from addiction. (Granfield and Cloud, 1999, 2004; White, 2006)

23. Recovery Capital Domains Best & Laudet (2010)

24. Consequences of Addiction Can Deplete Recovery Capital • Limited education • Minimal or spotty work history • Low or no income • Criminal background • Poor rental history • Bad credit; accrued debt; back taxes • Unstable family history • Inadequate health care

25. Creating and Reinforcing Recovery Capital Essential Ingredients for Sustained Recovery: • Safe and affordable place to live • Steady employment and job readiness • Education and vocational skills • Life and recovery skills • Health and wellness • Recovery support networks • Sense of belonging and purpose • Community and civic engagement

26. Creating and Reinforcing Recovery Capital Often, a Need to Address: • Legal issues • Criminal records • Financial status: debt, taxes, budgeting, etc. • Revoked licenses: professional, business, driver’s • Child custody • Relationship and parenting skills • Recovery support networks and community connections

27. Recovery Capital Assessment

28. Recovery-oriented Systems of Care

29. Service System Progression Arthur Evans

30. Service System Progression Arthur Evans

31. Service System Progression Arthur Evans

32. A New Model Arthur Evans

33. ROSC Recovery –oriented systems of care 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. William White

34. Focus: Recovery and Wellness Shifting from a crisis-oriented, professionally-directed, acute-care approach with an emphasis on discrete treatment episodes…. …to a person-directed, recovery management approach that provides long-term supports and recognizes the many pathways to health and wellness.

35. ROSC Vision for the Long-term The ROSC vision is more focused on personal possibilities than pathologies and more focused on continuity of long-term support in natural community relationships than the intensity of short-term professional interventions. Evans & White, 2013

36. Practice Guidelines: 10 Core Values

37. Three Approaches to System Transformation Adding peer and community-based recovery supports to the existing treatment system Additive Practice and administrative alignment in selected parts of the system – pilot projects Selective Cultural, values-based change drives practice, community, policy, and fiscal changes in all parts and levels of the system. Everything is viewed through the lens of and aligned with recovery-oriented care. Transformational Achara, Evans & King, 2010

38. Current Events

39. Consider This: The Opioid Epidemic

40. Consider This: Federal Policy

41. Consider This: Overdose Deaths

42. Consider This: Medication Assisted Treatment

43. Consider This: MAT Medication Assisted Treatment Is Here to Stay

44. Consider This: Medication Assisted Recovery

45. Consider This: Medication Assisted Recovery In the absence of a proactive recovery culture, the methadone maintenance patient becomes tied to an archetypal ‘spoiled identity’ to be managed and governed rather than to be retrieved, nurtured, and healed. White and Bamber (2010)

46. Consider This: Medication Assisted Recovery

47. Consider This: Methadone • Methadone has been used for decades to treat people who are addicted to heroin and narcotic pain medicines. • Patients taking methadone to treat opioid addiction must receive the medication under the supervision of a physician. • When taken as prescribed, it is safe and effective. • It allows people to recover from their addiction and to reclaim active and meaningful lives. • For optimal results, medication is augmented with counseling and social support. SAMHSA

48. Consider This: Methadone The length of time in methadone treatment varies from person to person. According to the National Institute on Drug Abuse publication, the length of methadone treatment should be a minimum of 12 months. Some patients may require treatment for years. Even if a patient feels that they are ready to stop methadone treatment, it must be stopped gradually to prevent withdrawal. Such a decision should be supervised by a doctor. SAMHSA

49. Consider This: Methadone Methadone can be addictive, so it must be used exactly as prescribed. This is particularly important for patients who are allowed to take methadone at home and aren’t required to take medication under supervision at an OTP. Methadone medication is specifically tailored for the individual patient (as doses are often adjusted and readjusted) and is never to be shared with or given to others. Patients should share their complete health history with health providers to ensure the safe use of the medication. SAMHSA

50. Consider This: Buprenorphine “Buprenorphine, like methadone, when taken in stable doses as part of a medically-supervised treatment plan, permits the patient to lead a normal and productive life without any of the narcotic effects of heroin or other opioids of abuse (sic).” SAMHSA and Legal Action Center