New Approaches to Substance AddictionRecovery Oriented Systems of Care(ROSC)
What is Different in 2013 than 1986 An explosion of research into addiction in the 1990’s and 2000’s. A growth in the number of people in recovery. It is estimated that for the first time in this country there are as many people in recovery as there are addicted to substances. (25-40 million) A groundbreaking 2013 study of over 3,200 persons in recovery….Involvement with the criminal justice system decreases by 10 times. 50% more pay taxes.
A Complex Picture Understanding addiction and what works in addiction treatment is challenging, in part, because: 1)poly-substance abuse and addiction has become the norm; and 2) there is a prevalence of co-occurring mental health disorders in this population In addition, the severity of addiction can vary widely.
Early Indicators—The ACE Study Adverse Childhood Events. A Kaiser Permanente study of 175,000 persons. Covered 7 areas: emotional abuse, physical abuse, sexual abuse, neglect, household substance abuse, violence towards mother and separation from a parent figure. Compared responses to medical charts. Four or more adverse events had risks 2 t0 10 times (more than for 0 events) for: Smoking and lung disease; Depression and suicide attempts; Pregnant or parenting as teen; and Alcoholism and drug abuse.
Other Significant Factors Age of onset. Risk of adult alcohol dependence directly related to onset. Before age 15, 40%. At age 18-19, risk drops to 16.5%. Environmental Factors: Family and Community Attitudes and Supports. AKA “Recovery Capital.”
A Few Things We Know… More than half of clients admitted to addiction treatment do not successfully complete treatment. The majority of people completing addiction treatment resume use in the year following treatment. Of those who consume alcohol or other drugs following discharge from addiction treatment, 80% will do so within 90 days of discharge.
We Also Know….. Acute stabilization of28-90 days (“Detox and hope for the best”) as generally practiced, is an approach with no evidence of long-term success for most people. Addiction, in all degrees of severity, is best understood as a chronic condition amenable only to long-term care similar to what you would receive for diabetes or hypertension.
More of What We Know….. Stable substance dependence recovery often follows multiple treatment episodes over years. Some programs target shortening the time lapsed BETWEEN treatment episodes by Continuing Care, AKA “Recovery Management.” This can consist of regular phone calls, visits, or “tune-ups.” One in 8 adult patients are linked to continuing care.
New Addiction Paradigms Shift system focus to Recovery rather than Clinical Intervention Extend the definition of addiction treatment from acute stabilization/recovery initiation to support for long term personal and family recovery/recovery maintenance and enhanced quality of life in recovery
Relapses About 50 to 70 percent of patients who are in treatment for diabetes, asthma, or hypertension don’t take their medications as prescribed and don’t follow through with recommended life changes suggested by their physicians. The relapse rates for addiction are about the same (roughly 50 percent per year). --Dr. Tom McLellan Former Deputy Director of ONDCP
What is Recovery? Recovery from addiction does not mean a “cure” from a disease but the creation of new resources internal and external that can support different healthy ways of satisfying one’s genuine needs. ----Dr. Gabor Mate
The Problem with Going Home “There are many clients for whom family and community are more a source of sabotage than support for recovery. The only solutions traditional models of treatment have to this dilemma are: 1)further bolster the individual’s resistance to such forces, or 2) to challenge the client to change his or her environment. An alternative is to change the family and community environment.” ---William White
Some of the issues potentially facing an adult in recovery Housing Legal Assistance Primary Health and dental care MH care Employment/job skills Relationships/Parenting Banking; Credit Repair Driver’s licenses Basic Education Civic Participation Living skills Spiritual/Emotional Support
Recovery Oriented Systems of Care (ROSC) Networks of formal and informal services, supports, opportunities and relationships mobilized to sustain long term recovery for individuals and families. ROSC is not a treatment program, government agency or a partnership of mutual aid groups, but a macro level organization of a community or state.
ROSCs Growing in New Mexico The Behavioral Health Services Division is leading this initiative by holding statewide meetings every other month, presenting different topics, communities and projects statewide. (Contact Vicki if you want to be on the email list at email@example.com) Current Initiatives: Taos. a Coalition of Taos Alive (DFC grant), Recovery Friendly Taos County and Crisis System of Care. In Mescalero, the Mescalero System of Care. In Roswell and Albuquerque, WINGS for LIFE are foundations of ROSCs for the re-entry population. In Farmington, coalitions like Totah Behavioral Health and Alternative Sentencing Division of SJ County
Hope In most communities, individuals return from treatment with little sense of accomplishment and little or no understanding of how to rebuild their lives and who to turn to. If the community rejects such a person, where does the hope come from?
A Final Thought Those who are least likely to complete treatment (or re-use) are not those who want it the least but rather those who……... …need it the most.
The 12 Guiding Principles of Recovery There are many pathways to recovery. Recovery is self-directed and empowering. Recovery involves a personal recognition of the need for change and transformation. Recovery is holistic. Recovery has cultural dimensions. Recovery exists on a continuum of improved health and wellness. Recovery is supported by peers and allies. Recovery emerges from hope and gratitude. Recovery involves a process of healing and self-redefinition. Recovery involves addressing discrimination and transcending shame and stigma. Recovery involves (re)joining and (re)building a life in the community. Recovery is a reality. It can, will, and does happen. Source: CSAT White Paper: Guiding Principles and Elements of Recovery-Oriented Systems of Care.
For Further Information Vicki Ohrn-Lannerholm, Clinical Staff Manager, Behavioral Health Services Division, Human Services Department firstname.lastname@example.org 505-476-9280 Great web site: facesandvoicesofrecovery.org Great video: Anonymous People