ADAA Management Conference 2009Virgil Boysaw and Sue Jenkins, Presenters

Describe elements of Recovery Oriented Systems of Care

Identify the conceptual foundation for prevention services in a ROSC system

Describe similarities and opportunities for partnership in SPF and ROSC processes

Identify cross-functional skills that support partnerships between prevention and treatment professionals

Continuum from non-use to regular heavy use

Diagnostic classifications Substance Abuse and Substance

Dependence

Wider span of problematic use is not captured in diagnostic classifications

When problems are of later onset and lower severity, many persons resolve them on their own or through brief intervention outside specialized addiction treatmentSustained abstinenceSustained moderated AOD useContinued sub-clinical problemsMove between patterns

Marked differences

Greater personal vulnerability Family history of substance use

disorders Child maltreatment Early puberty Early age of onset of AOD use Personality disorders during early

adolescence Substance using peers Greater cumulative lifetime adversity

Greater severity and intensity Greater AOD related consequences Higher rates of developmental trauma

and posttraumatic stress disorder Higher co-occurrence of other

medical/psychiatric illness Greater personal and environmental

obstacles to recovery Lower levels of recovery capital

Natural recovery is the predominant pathway of resolution for transient substance-related problems and less severe substance use disorders

professionally directed treatment is the dominant pathway of entry into recovery from substance dependence

Community studies of recovery from alcohol dependence report long-term recovery rates approaching or exceeding 50%.

All based on acute models of care

Services are delivered in a uniform series of encapsulated activities screening, admission, a single point-in-time assessment, a short course of minimally

individualized treatment, Discharge and brief “aftercare”,

followed by termination of the service relationship.

Focused on symptom elimination for a single primary problem

A professional expert directs and dominates decision-making throughout this process.

Services transpire over a short period of time. pre-arranged, time-limited insurance payment

designed specifically for addiction disorders and “carved out” from general medical insurance

At discharge, “cure has occurred:” long-term recovery is then viewed as self-sustainable without on-going professional assistance.

Evaluation of success occurs at a single point-in-time follow-up, typically just months after treatment.

Post-treatment relapse is viewed as the failure (non-compliance) of the individual, rather than potential flaws in the design of the treatment protocol.

(Hubbard, Flynn, Craddock, & Fletcher, 2001); (Watkins, Pincus, Tanielian, & Lloyd, 2003)

Low Treatment Compliance 50% of outpatients drop out of

treatment within one month 40% of court-ordered patients do

not complete treatment

Relapse Rates are High About 60% use drugs within six

months following treatment discharge

(O'Brien & McLellan, 1996)

Addiction Alcohol Opioid Cocaine Nicotine

30-50%30-50%30-50%30-50%

50%40%45%70%

Insulin Dependent Diabetes Medication Diet and Foot Care

<50%<50%

30-50%30-50%

Hypertension Medication Diet

<30%<30%

50-60%50-60%

Asthma Medication <30% 60-80%

Intervene earlier in the progression of the disease

Improve treatment outcomes

Support sustained recovery

Outreach Engagement and

intervention services

Recovery guiding or coaching

Post treatment monitoring and support

Abstinence → WellnessRecovery Support Services

Sober or supported housing

Transportation Childcare Legal services Educational/

vocational supports

Improved Quality of Treatment Emphasis on outreach, access and engagement Evidence based practices Individualized treatment, more choices Increased family involvement Integration with physical health and mental health

servicesChange in nature of helping

relationship

Active Relationship with Community“The community, not treatment, is the agent of recovery”

Advocacy ▪ Confront AOD promotional forces in the local community▪ Promote pro-recovery policies

Recovery resource development▪ Recovery community centers▪ Alternative peer recovery support groups

Stigma reduction efforts

Create communities in which people have a quality life including healthy environments at work and in school; supportive communities and

neighborhoods; connection to families and friends and an environment which is free of alcohol,

tobacco, and other drugs and crime free

(SAMHSA/CSAP, 2006)

Prior to SPF, prevention was defined as an intervention in which specific groups, families or individuals were targeted (i.e. selected or indicated)

The goal of this approach was to build individual protective factors while reducing risk factors

(NIDA 1997, 2003)

Bring the power of individual citizens and institutions together

Create a comprehensive plan that everyone has a stake in and owns

Foster continued systems approaches as the community experiences the outcome of its investments

Hold community institutions responsible (CSAP, 2006)

By consumption amount, consequences associated with consumption and success in preventing the problems associated with use

Across the lifespan (not just with youth)Based on evidence-based research and

empirical dataAs outcomes at the population level

(not just program level)

Prevention can be enhanced to address any and all factors that lead to use or lessening of wellness or loss of sustained recovery by adapting current prevention strategies to a Recovery and Wellness model (grounded in a Chronic Care model)

(Hogan, Gabrielson, Luna, & Grothaus, 2003)

Focus is on building resiliency The strength individuals and

communities attain by reducing risk factors and increasing protective factors

Rather than addressing a single problem or condition, it simultaneously considers a potential wide-ranging set of ATOD-involved problems

Rather than focusing on individuals at risk, it studies the entire community

Rather than basing prevention strategies on single assumptions about deterministic behavior, it employs interventions that alter the social, cultural, economic and physical environment in such a way as to promote shifts away from conditions that favor the occurrence of ATOD- involved problems.

(Holder, 1998)

Special Report A Unified Vision for the Prevention and

Management of Substance Use Disorders: Building Resiliency, Wellness and Recovery – A Shift from an Acute Care to Sustained Care Recovery Management Model

Complied by: Michael T. Flaherty, PhD Institute for Research, Education and

training in Addictions (IRETA)