The Intersection of Prevention and Recovery: Community

1
The Intersection of Prevention and Recovery
Community
2
How does a Recovery Oriented System of Care
change the delivery of addiction treatment
services?
3
Alcohol and Drug Use in the Community

• 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

4
Natural Recovery

• When problems are of later onset and lower
  severity, many persons resolve them on their own
  or through brief intervention outside specialized
  addiction treatment
• Sustained abstinence
• Sustained moderated AOD use
• Continued sub-clinical problems
• Move between patterns

5
Community vs. Clinical Populations

• 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

6
Clinical Populations

• 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

7
Community vs. Clinical Populations

• 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

8
Recovery Rates

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

9
Past Models of Addiction

• All based on acute
• models of care

10
Acute Care Model of Treatment

• 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.

11
Acute Care Model

• 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

12
Acute Care Model

• 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.

13
Evidence from Acute Care Models

• 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

14
Addiction/Chronic Illness Compliance Rate
Relapse Rate
15
Recovery-Oriented System Goals

• Intervene earlier in the progression of the
  disease
• Improve treatment outcomes
• Support sustained recovery

16
Acute Care Model ? Recovery Oriented System of
Care

• Abstinence ? Wellness
• Recovery Support Services

• Outreach
• Engagement and intervention services
• Recovery guiding or coaching
• Post treatment monitoring and support

• Sober or supported housing
• Transportation
• Childcare
• Legal services
• Educational/vocational supports

17
Recovery Oriented System of Care

• 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 services
• Change in nature of helping relationship

18
Recovery Oriented System of Care

• 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

19
How does the Strategic Prevention Framework
change the provision of prevention services?
20
Strategic Prevention Framework

• 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)

21
Strategic Prevention Framework

• 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)

22
S PF Goals

• 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)

23
SPF Measures

• 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
  data
• As outcomes at the population level (not just
  program level)

24
Unified Model

• 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)

25
Recovery and Wellness Model

• 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

26
Recovery and Wellness Model

• 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)

27
Reference

• 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)