SUPPORT TO ADDICTION RECOVERY

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SUPPORT TO ADDICTION RECOVERY
A Model Developed By the Office of Behavioral
Health Services Division on Alcoholism and Drug
Abuse October, 2001 Revised, 10/04 Program
Development Supported In Part With Substance
Abuse Treatment and Prevention Block Grant Funds
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Support To AddictionRecovery

• On-Going Assessment Evaluation
• Specialized Programs
  Withdrawal Management
• Basic Elements for
  Pre-Recovery Interim
• Successful Outcomes
  Services
• Intensive
  Recovery Programs
• 
  (IRPs)

STAR
Customer
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STAR

• An Abstinence-Based Model
• Requires Intensive Engagement of the Customer
• Requires Ninety-Day Minimum Engagement in
  Treatment
• Based on Best Practices for Addiction Services
• Recognizes That No Single Recovery Plan Is
  Appropriate for All Individuals
• Recovery Services Need to Be Readily Available
• Recognizes That Relapse May Be A Part of Recovery
• Individual Customers With Co-Existing Psychiatric
  Disorders Should Have Both Disorders Treated in
  An integral Way

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Addiction Recovery Principles

• Recovery Is A Long-Term Process and Frequently
  Requires Multiple Episodes of Care
• The Process of Recovery Has a Spiritual Component
  and Is Enhanced by Peer Support, Mentoring, and a
  Therapeutic Community Approach Among Other
  Methods
• Recovery Leads to An Established Life-Change
  Conducive to a Healthy, Productive Life-Style,
  and Is Not Merely the Discontinuance of Use of An
  Addictive Substance

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Addiction Recovery Principles (Cont.)

• Detoxification Is Only The initial Stage of
  Addiction Recovery And By Itself Does Little to
  Change Long-Term Use
• Addiction Recovery Does Not Need to Be Voluntary
  to Be Effective

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Main Components

• On-Going Assessment and Evaluation
• Multiple Withdrawal Management Programs
• PI Shelters
• Detainee Shelters
• Withdrawal Management Within Programs
• Medical Detoxification Services
• Pre-Recovery Interim Service Providers
• Intensive Recovery Programs (IRPs)

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Main Components (Cont.)

• Basic Elements to Support Recovery for Successful
  Outcomes
• Specialized Programs
• Womens
• Co-Occurring
• Chronic
• Other

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On-Going Assessment Evaluation

• Assessment and Evaluation Are Continual Processes
  Throughout the Customers Involvement with STAR
• Utilizes ASAM Criteria for Proper Placement
• May Include Informal as well as Formal Assessment
  Methods
• Effective Assessment and Subsequent Care Attends
  to Multiple Needs of the Individual, Not Just His
  or Her Use of Substances

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On-Going Assessment Evaluation (Cont.)

• Includes an Initial Screening for Risk of HIV,
  STDs, TB, and Hepatitis with Appropriate
  Referrals for Service
• Continuous Monitoring of Alcohol and Other Drug
  Use During Treatment Can Help the Individual
  Withstand Urges to Use Alcohol and Other Drugs

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Withdrawal Management

• Utilize Withdrawal Protocols
• Primarily a Non-Medical Model
• Withdrawal Symptom Management
• Utilization of Medical Management as an Adjunct
  to Other Recovery Services
• Methadone, Naltraxone, Buprenorphrine, other
  appropriate medications
• Availability of Medical Detoxification Services
  (lt5)

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Pre-Recovery Interim Services

• If a Customer Is Assessed and Found Not Yet Ready
  for Treatment, the Following Pre-Recovery Interim
  Services Must Be Available
• Motivational Counseling
• Pre-Treatment Groups
• Referral for Public Health Services
• HIV, TB, etc.
• Pre-Natal Care
• Other

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Intensive Recovery Programs(IRPS)

• 90 Day Minimum Engagement
• Easily Accessible to the Customer
• Residential, Outpatient, or a Combination
• Tied-In to Basic Elements for Successful Outcomes
• Peer Support/Mentors
• Housing
• Transportation
• Child Care
• Education
• JobTraining
• The Criminal Justice System

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IRPS (Cont.)

• Coordination with Community Support Services
• On-Going Assessment and Evaluation (Both Formal
  and Informal)
• Co-Occurring Capable
• Three Phase Process

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IRP Phase 1

• 5 to 6 Weeks in Duration
• 12 to 18 Hours a Week
• Day and Evening Programming As Needed
• Didactic Educational Component
• Weekend Activities/Involvement

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IRP Phase 2

• The Following 6 Weeks
• Decreasing Intensity with Continuing Community
  Support
• More Attention to Individual Needs
• Vocational
• Educational
• Life-Skills

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IRP Phase 3Transition to the Community

• Assessment of an Individuals Progress,
  Strengths, and Support System Determines
  Discharge from the IRP
• Continuing Community Support Service
• Housing Assistance
• On-Going Education and Job Training
• Employment Opportunities
• Peer Support/Mentoring
• Identification of Therapeutic Intervention Needs
• Relapse Prevention/Aftercare Groups

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Basic Elements for Successful Outcomes

• Staff (IRP and Community Care Coordinators)
• Shelter
• Transportation
• Child Care
• Therapeutic Community Model
• Training (CAC/CIS) and Cross-Training (SA/MH)
• Access to Vocational and Educational Training
• Employment Opportunities

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IRP Staff

• Mix of Clinical/Non-Clinical, Recovering/Non-Recov
  ering, Degreed/Non-Degreed
• Educational Background and Experience Consistent
  with Job Function
• Nuturing, Empathetic, and Supportive, but Not
  Enabling
• Well-Trained in Job Role
• Cross-Trained Regarding Co-Occurring Disorders
• Philosophy of Care Congruent with Best Practices

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Clinical Input IntoRecovery Process

• Clinicians Will Be Used to Provide Quality
  Control
• Clinicians Will Utilize Assessment Criteria (ASAM
  Placement, ASI, SASSI, Etc.)
• Clinicians Will Provide Therapeutic Interventions
  When Needed as an Adjunct to Recovery

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Community Care Coordinators(CCCS)

• Outreach
• After-Care
• Case Coordination
• Community Treatment Resources Development
• Utilization of Local Recovering Individuals as
  CCCs Enhances Outcomes for the Custome
• Utilization of Peer Recovery Network

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Peer Support Services

• Peer Support is
• Being open to new ways of thinking about our
  experience
• Re-defining help and helping
• A way of thinking about relationships and power
  that is mutual
• Considering the effects of trauma and abuse on
  peoples self-concept and relationships
• Mutually supportive and mutually responsible
• Teaching and learning from each other
• An opportunity to challenge the status quo
• About recovery and transformation

• Peer Support is not
• An expert telling you what your experience means
• Telling someone what to do
• Superficial power-down relationships
• Telling you youre sick and socially unacceptable
• One way relationships where one person takes
  responseibility for the other
• Being told or learning about diagnoses and
  treatment
• Protecting people from taking risks that are too
  stressful
• About stability and maintenance

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Shelter (Transitional Living)

• Comfortable, Home-Like, Family Atmosphere
• Safe, Secure, Nurturing
• Therapeutic Community
• Life-Skills Training
• Provides for Personal Safety and Safety of
  Belongings
• Provides for Secure Medication Management

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Transportation

• Must Be Provided Within the Program
• Transportation To and From the Program
• Transportation for Attending Program Elements
• Must Be Provided as a Part of Community Support
• Transportation to Vocational and Educational
  Training
• Transportation to Peer Support Meetings and Other
  Support Elements
• Transportation to Relapse Prevention/Aftercare
  Groups
• May Be Provided in Collaboration with Other
  Agencies and Programs

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Child Care

• Required of All Programs Serving Women
• Must Offer Prevention Programming for the
  Children
• Trained Community Volunteers
• Coordinated by the CDs

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Specialized Programs

• Long-Term Chronic Unit
• Womens Programs
• Co-Occurring Enhanced Unit

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Long-Term Chronic Unit

• Chronic Addicts Only
• 9 Months to 2 Years in Duration
• Homeless
• Unemployed
• No Support System
• Multiple Treatment Failures
• Medically Compromised
• 9 Months to 2 Years in Duration
• Court-Ordered or Committed

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Long-Term Chronic Unit (Cont.)

• Provides Physical/Health Care
• Provides Opportunities for Therapeutic Use of
  Time
• Therapeutic Community Approach
• Educational Groups
• Peer Support/Fellowships
• Step-Down Program
• Strong Discharge Plan

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Womens Programs

• Emphasis on Pregnant Women and Women with
  Dependent Children
• Residential with 6 Month Minimum Stay
• Must Meet Federal Guidelines for Womens Programs
• Groups Specific to Womens Needs
• Abuse
• Anger Management
• Parenting
• Others
• Medical Care Including Pre-Natal Care If Needed
• Child Care
• Other

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Womens Programs (Cont.)

• Must Provide Extensive Wrap-Around Services
• Must Provide the Basic Elements for Successful
  Outcomes of STAR
• Must Provide the Basic Elements for Successful
  Outcomes of STAR

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Co-Occurring Enhanced Program

• All Referrals from MICA Units
• Access to Psychiatrist
• Medical and Medication Management, Including
  Psychotropic Medications
• Cross-Trained Staff

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Outcomes

• Outcome evaluations must be collected at 3
  months, 6 months, and 1 year after discharge
• Continuing community support services must be
  provided during this time with a frequency and
  intensity congruent with the individuals needs

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GOOD-BYE

• Thank You for Your Attention and Support