2/3/14 1 A presenta*on by the NAADAC, the Associa*on for Addic*on Professionals WHAT DOES SCIENCE SAY? REVIEWING RECOVERY RESEARCH Presented by William “Bill” White February 5, 2014 Download the PowerPoint slides & access CE quiz here: www.naadac.org/whatdoessciencesayreviewingrecoveryresearch Misti Storie, MS, NCC WEBINAR ORGANIZER Director of Training & Professional Development NAADAC, the Associa/on for Addic/on Professionals USING GOTOWEBINAR • Control Panel • Asking Questions • PowerPoint Slides • Polling Questions • Audio (phone preferred) www.naadac.org/ whatdoessciencesayreviewing recoveryresearch A presenta*on by NAADAC, the Associa*on for Addic*on Professionals A COMPONENT OF THE RECOVERY TO PRACTICE (RTP) INITIATIVE www.naadac.org/recovery OBTAINING CE CREDIT o The educa/on delivered in this webinar is FREE to all professionals. o 2 CEs are FREE to NAADAC members who aBend this webinar. Nonmembers of NAADAC receive 2 CEs for $25. o If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar) www.naadac.org/whatdoessciencesayreviewingrecoveryresearch www.naadac.org/webinars A CE cer/ficate will be emailed to you within 21 days of submiXng the quiz and payment (if applicable) – usually sooner. o Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate. Free to NAADAC Members!
Transcript
2/3/14
1
A presenta*on by the NAADAC, the Associa*on for Addic*on Professionals
WHAT DOES SCIENCE SAY? REVIEWING RECOVERY RESEARCH
Presented by William “Bill” White February 5, 2014
Download the PowerPoint slides & access CE quiz here:
Through the Recovery to Prac/ce (RTP) Ini/a/ve, NAADAC was asked to determine the extent to which recovery-‐oriented concepts, values, and prac/ces exist within all aspects of the addic/on profession in order to develop a recovery-‐oriented training curriculum for the workforce.
FINDINGS FROM SITUATIONAL ANALYSIS
o understand recovery-‐oriented concepts
o u/lize recovery-‐oriented prac/ces
o have recovery-‐related opportuni/es for educa/on, training, literature, cer/fica/on, and licensure
o Gaps s<ll remain.
In general, members of the addiction profession:
FINDINGS FROM SITUATIONAL ANALYSIS
o Many states are s/ll in the early implementa/on stages of formally shiaing to a recovery orienta/on.
o The response of the addic/on profession to recovery concepts is generally enthusias/c whilst being met with apprehension from the workforce.
2/3/14
3
FINDINGS FROM SITUATIONAL ANALYSIS
o Many economic and poli/cal challenges to integra/ng a full recovery orienta/on within the addic/on profession were discovered (funding and policy issues).
o In addi/on, social challenges (workforce resistance to change) and technological barriers (lack of full electronic records) also impede the adop/on of a recovery orienta/on.
FINDINGS FROM SITUATIONAL ANALYSIS
o trauma-‐informed care
o cultural diversity
o medica/on-‐assisted treatment
o co-‐occurring disorders
o role of peer recovery coaches
Special attention is needed in these areas:
RECOVERY RESEARCH OVERVIEW
RECOVERY RESEARCH LIMITATIONS
o Research agenda driven by addic/on, treatment, and recovery paradigms
o Limited number & scope of recovery research studies
o Few controlled replica/ons; proba/onary status of what we do know
o Many cri/cal ques/ons remain virtually unexplored
o Good news: Recovery research increasing; methodological rigor is improving
RECOVERY RESEARCH REVIEWS
o For free recovery research monograph downloads, go to www.williamwhitepapers.com
o Complete cita/ons for most of the points in this webinar can be found in White, W., & Kurtz, E. (2006). The varie/es of recovery experience. Interna<onal Journal of Self Help and Self Care, 3(1-‐2), 21-‐61.
RECOVERY DEFINITION REVIEW
Webinar #1 in RTP Series • Posi/ve, substan/ve and sustained change in the person-‐drug rela/onship
• Improvement in global health
• Repair of person/community rela/onship, e.g., ci/zenship (White, 2007)
2/3/14
4
RECOVERY PREVALENCE
o Recovery prevalence studies limited using 3-‐component recovery criteria
o Conclusions from White, 2012 review of 415 SUD remission studies, 1868-‐2012
RECOVERY PREVALENCE
14 community studies reported both SUD remission and abs/nence rates. An average of 43.5% of people who met life/me SUD diagnos/c criteria achieved remission.
Only 17.9% did so through complete abs/nence.
RECOVERY PREVALENCE
50 adult clinical studies reported both SUD remission and abs/nence rates
Average remission rate of 52.1%, average abs/nence rate was 30.3%.
ADULT VERSUS ADOLESCENT REMISSION RATES
o Average adolescent remission rate was 42% (an average of 35% for studies conducted since 2000)
o Rates of adolescent post-‐treatment AOD use are high, but longer-‐term outcomes portray a more posi/ve picture.
RECOVERY PREVALENCE
o The differences between remission rates and abs/nence rates reflect differences in problem severity across community and clinical popula/ons (e.g., epidemiologist’s illusion versus clinician’s illusion)
o Abs/nence-‐based remission more stable over /me than remission via moderated AOD use
CONDUCTING LOCAL RECOVERY PREVALENCE SURVEYS
o Surveys of recovery prevalence can be methodologically challenging and expensive
o Recommended strategy: Imbed recovery prevalence ques/ons in exis/ng community surveys
o See White, et al, 2013, Journal of Psychoac/ve Drugs, 45(4), 287-‐296.
2/3/14
5
CLINICAL VERSUS COMMUNITY POPULATIONS
o Greater personal vulnerability, e.g., family history, atypical AOD response, early age of onset, developmental trauma, parental/sibling modeling, etc.
o Greater Problem Severity
o Greater Problem Complexity
o More environmental obstacles to recovery
o Lower recovery capital
RECOVERY PREVALENCE
o Rates of SUD remission in major epidemiologic studies range from 5.3% to 15.3% of adult popula/on (not including remission for nico/ne dependence)
o Those rates create es/mates of 25-‐40 million adults in SUD remission (mee/ng life/me but not past year SUD diagnos/c criteria)
DEGREE OF CHANGE ACROSS 3 “ZONES” OF RECOVERY
Par*al Recovery
Full Recovery Amplified/
Transcendent Recovery
*Lack of instrumenta/on to measure
PATHWAYS OF RECOVERY
o By framework of meaning (secular, spiritual, religious)
o Frameworks mirrored by secular, spiritual & religious recovery mutual aid organiza/ons • See Faces and Voices of
Recovery Mutual Aid Guide
PATHWAYS OF RECOVERY
o By context of recovery (solo/natural recovery, peer-‐assisted recovery, professionally-‐assisted recovery, medica/on-‐assisted recovery, cultural pathways of recovery -‐ categories not mutually exclusive)
o Pathway mapping incomplete
AUDIENCE POLLING QUESTION
Do you know someone whose recovery was sudden, unplanned, positive and permanent?
2/3/14
6
STYLES OF RECOVERY INITIATION
Incremental change
Quantum change (transforma/ve
change)
Maturing out (consequences and developmental matura/on)
DriD (associated with larger
lifestyle shias)
STAGES OF RECOVERY
WALDORF (1983, 1991)
Going through changes, forming a resolve, cessation experiments, becoming an ex-addict, learning to be ordinary, filling the void
SAMPLING: STAGES OF RECOVERY
FRYKHOLM (1985)
ambivalence, lengthening periods of abstinence, emancipation to an ex-addict identity
SAMPLING: STAGES OF RECOVERY
BIERNACKI (1986)
resolution to quit, detachment from the physical and social worlds of addiction, managing cravings and impulses while staying abstinent, and becoming ordinary
SAMPLING: STAGES OF RECOVERY
SHAFFER (1989)
experiencing turning points, active quitting, relapse prevention
SAMPLING: STAGES OF RECOVERY
2/3/14
7
KLINGEMANN (1991)
motivation, action, maintenance
SAMPLING: STAGES OF RECOVERY
PROCHASKA ET AL (1992)
precontemplation, contemplation, planning, action, maintenance, and termination
SAMPLING: STAGES OF RECOVERY
WHITE (2008)
precovery, recovery initiation & stabilization, recovery maintenance, enhanced quality of personal/family life in long-term recovery, breaking inter-generational cycles or problem transmission
SAMPLING: STAGES OF RECOVERY
STYLES OF RECOVERY
RECOVERY IDENTITY
Recovery-‐Neutral Iden*ty
Recovery-‐Posi*ve Iden*ty
Recovery-‐Nega*ve Iden*ty (s*gma, shame)
AUDIENCE POLLING QUESTION
I have observed families who broke up via separation or divorce following addiction
recovery.
2/3/14
8
RELATIONAL STYLES IN RECOVERY
Acultural/ Disengaged Bicultural Culturally
Enmeshed Virtual Recovery
Styles can evolve over the course of long-‐term recovery -‐ in mul/ple direc/ons
ROLE OF RECOVERY MUTUAL AID
o Limita/ons, AA-‐focused, role in early recovery of clinical popula/ons
o Value in recovery ini/a/on & maintenance
o Ac/ve Ingredients
o Effec/veness across diverse popula/ons
ROLE OF OTHER RECOVERY SUPPORT INSTITUTIONS
o Substan/al effec/veness evidence on Oxford House and Sober Living Residences in CA
o -‐-‐See NARR Research Report
o Mostly descrip/ve reports on recovery schools
o No replicated research on recovery industries, ministries, community centers, cafes, etc.
ROLE OF OTHER RECOVERY SUPPORT INSTITUTIONS
o Very limited research to date on recovery support services/recovery coach role (See White, 2009 Peer Recovery Support Monograph)
o Strong support for value of recovery checkups and telephone-‐based recovery support but mostly in research rather than clinical or recovery support seXngs
RECOVERY DURABILITY
When does sobriety today predict sobriety for life? Point in recovery at which risk of future SUD reoccurrence drops below 15% is found across many studies to be in the 4-‐5 year window of sustained recovery. * Clinical Implica/ons
AUDIENCE POLLING QUESTION
I have observed families who broke up via separation or divorce following addiction
recovery.
2/3/14
9
FAMILY RECOVERY
o Brown & Lewis’ “trauma of recovery”
o Preliminary work on stages of family recovery & need for “scaffolding”
o Zones of family recovery (system as a whole, subsystems, individual members; family-‐community rela/onship)
o Need for sustained family support across the recovery life cycle— Brown’s “scaffolding” concept
IMPLICATIONS FOR ADDICTION PROFESSIONALS
1) Mul*ple recovery pathways/styles, choice philosophy & expanding service menus
IMPLICATIONS FOR ADDICTION PROFESSIONALS
2) Cultural fluency: Working clinically within and across mul*ple pathways and styles of recovery
IMPLICATIONS FOR ADDICTION PROFESSIONALS
3) Search for individually potent service/support combina*ons and sequences
IMPLICATIONS FOR ADDICTION PROFESSIONALS
4) Trend toward mainstreaming of sustained recovery supports
IMPLICATIONS FOR ADDICTION PROFESSIONALS
2/3/14
10
5) Poten*al roles of addic*on professionals outside addic*on treatment sehngs and beyond the stage of recovery ini*a*on
IMPLICATIONS FOR ADDICTION PROFESSIONALS
6) Asser*ve vs. passive linkage procedures to community-‐based recovery support resources
IMPLICATIONS FOR ADDICTION PROFESSIONALS
7) Need for sustained monitoring and support across the stages of long-‐term personal & family recovery
IMPLICATIONS FOR ADDICTION PROFESSIONALS
THANK YOU!
ASKING QUESTIONS
Ask ques/ons through the Ques/ons Pane
OTHER RTP WEBINARS
www.naadac.org/webinars
Defining Addic*on Recovery • Thursday, January 9, 2014 @ 3-‐4:30pm ET
What Does Science Say? Reviewing Recovery Research • Wednesday, February 5, 2014 @ 3-‐5pm ET
The History of Recovery in the United States and the Addic*on Profession • Thursday, March 6, 2013 @ 3-‐5pm ET
Defining Recovery-‐Oriented Systems of Care (ROSC) • Thursday, April 3, 2014 @ 3-‐4:30pm ET
Understanding the Role of Peer Recovery Coaches in the Addic*on Profession • Thursday, May 1, 2014 @ 3-‐4:30pm ET
Including Family and Community in the Recovery Process • Thursday, May 29, 2014 @ 3-‐5pm ET
Collabora*ng with Other Professions, Professionals, and Communi*es • Thursday, June 26, 2014 @ 3-‐4:30pm ET
Using Recovery-‐Oriented Principles in Addic*on Counseling Prac*ce • Thursday, July 24, 2014 @ 3-‐5pm ET
Exploring Techniques to Support Long-‐Term Addic*on Recovery for Clients and Families • Thursday, August 21, 2014 @ 3-‐5pm ET
2/3/14
11
WEBINARS ON DEMAND
• Medica<on Assisted Treatment • Building Your Business with SAP/DOT • SBIRT • Billing and Claim Submission • Ethics • Co-‐occurring Disorders • Test-‐Taking Strategies • Conflict Resolu<on • Clinical Supervision • ASAM Placement Criteria • DSM-‐5 Proposed Changes
www.naadac.org/webinars
CE credit s<ll available!
Free to NAADAC Members!
WWW.NAADAC.ORG
OBTAINING CE CREDIT
o The educa/on delivered in this webinar is FREE to all professionals.
o 2 CEs are FREE to NAADAC members who aBend this webinar. Non-‐members of NAADAC receive 2 CEs for $25.
o If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)
