The Dawn of a New Day: Transforming New Mexico Towards

Recovery- Oriented Systems of Care

Dr. Bob PhillipsEastern New Mexico University-Roswell

ROSC Workgroup Meeting September 21, 2012www.bob.phillips@roswell.enmu.edu

First… some definitions

Recovery is “a voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship.”

The Betty Ford Institute Consensus DefintionJ. Substance Abuse Trt, 2008

REMISSION Remission can be characterized as changes in

substance use behaviors to subclinical levels (i.e, no longer meets the diagnostic criteria)

The person is asymptomatic (no apparent negative use consequences.

Reliably associated with abstinence, remission

is also associated with reduced, controlled or moderate use in some persons.

Severe

Substantial

Moderate

Mild

None

2M PEOPLE (0.8 %) RECEIVING TREATMENT

21 M (7%)NEEDING BUT NOT RECEIVING TREATMENT

307, 000,000PEOPLE IN THE US

Distribution of Substance Use Problems & Treatment

60-80 M (20-25%) USING AT RISKY LEVELS AND ALMOST NEVER SEEN

Substance abuse careers last for decadesCu

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Median duration of 27 years from

first use to first year of

recovery

Dennis & Scott (2004)

Substance abuse careers are shortened by treatment

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Years from first Tx to 1+ years abstinence 2520151050

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Median duration of 8 years and 3 to 4

episodes of care

Dennis & Scott (2004)

7

The Larger Recovery Community

Only 1 in 8 adult patients are systematically linked to continuing care or recovery supports.

Only 36% of adolescents get ANY continuing care

The Historical SituationThe Treatment Field

8

Recovery Community

Treatment Field

What we have to do better…

BRIDGE the gap!

How many persons in the US are in Recovery from Substance Use Disorders

?

March 2012… The best answers yet

Recovery/Remission from Substance Use

Disorders: An Analysis of Reported Outcomes

in 415 Scientific Reports, 1868-2011

William L. White, MAPhiladelphia Department of Behavioral

Health andIntellectual disAbility Services

Great Lakes Addiction Technology Transfer Center

http://www.attcnetwork.org/learn/topics/rosc/docs/RecoveryRemissionWW.pdf

The Prevalence of SUD Recovery in the United States

• Based on this analysis, the percentage of adults in the general population of the United States in remission from substance use disorders ranges from 5.3% to 15.3%.

• These rates produce a conservative estimate of the number of adults in remission from significant alcohol or drug problems in the United States at more than 25 million people.

• This yields a potential range of 25 to 40 million (not including those in remission from nicotine dependence alone).

What percentage of people who develop AOD problems eventually achieve recovery?

• Of adults in the general population who once met lifetime criteria for substance use disorders, an average of 49.9% (53.9% in studies conducted since 2000) no longer meet those criteria.

• In community studies reporting both remission rates and abstinence rates for substance use disorders, an average of 43.5% of people who have ever had these disorders achieved remission, but only 17.9% did so through a strategy of complete abstinence.

• The data underscore significant differences between persons drawn from clinical or treatment samples and persons studied in community samples!

What is the rate of recovery for persons with severe enough SUD to have received professional treatment?

• In an analysis of 276 addiction treatment follow-up studies of adult clinical samples, the average remission/recovery rate across all studies was 47.6% (50.3% in studies published since 2000).

• Within studies with sample sizes of 300 or more and studies with follow-up periods of five or more years, average remission/recovery rates were 46.4% and 46.3%, respectively.

• In the 50 adult clinical studies reporting both remission and abstinence rates, the average remission rate was 52.1%, and the average abstinence rate was 30.3%.

• Based on available information, this 21.8% difference appears to reflect the proportion of persons in post-treatment follow-up studies who are using alcohol and/or other drugs asymptomatically or are experiencing only subclinical problems (problems not severe enough to meet diagnostic criteria for substance use disorders).

Does the rate of recovery for treated adolescents differ from that of adults who after treatment?

• Yes….

• The average recovery/remission rate following specialty adolescent treatment was 42% (an average of 35% for studies conducted since 2000) compared to an average recovery/remission rate of 47.6% reported in the adult studies (50.3% average for studies conducted since 2000).

• Interpretation caveats include the greater number of adult studies, larger sample sizes, and much longer follow-up periods in the adult studies.

• While the high percentage of adolescents who report some AOD use in the months following treatment is discouraging, studies of the longer trajectories of AOD use confirm post-treatment increases in abstinence, reductions in use, and gains in global health among treated adolescents.

• There is cause for optimism regarding adolescents’ long-term prospects for recovery from substance use disorders.

local communities should establish baseline recovery prevalence data to guide and evaluate recovery-focused systems-transformation efforts

• Communities could easily integrate recovery prevalence questions into regular community health surveys.

• These data could guide recovery-focused systems transformation efforts and also evaluate planned interventions in particular service areas.

• We could evaluate service needs by zip codes/planning areas and match treatment/recovery support resources to those areas where levels of problem severity are highest and levels of recovery capital are lowest).

The Addiction / Recovery Tipping Point

THE NUMBER OF PEOPLE IN

ADDICTION

THE NUMBER OF PEOPLE INRECOVERY

The Tipping Point

• The moment of critical mass• The dramatic moment in an

epidemic when everything changes at once

• Things tip because of the dramatic efforts of a select few

• In order to create one contagious movement you might have to create several small ones

The Structure of Social Epidemics• Law of the Few

In a given process or system some people matter much more than others.

• Stickiness FactorMaking a contagious message memorable: relatively simple changes in the presentation & structuring of information that make a big difference in impact.

• Power of ContextHuman Beings are much more sensitive to their environment than we presume

CONNECTORS, MAVENS, & SELLERS• These are exceptional people who are capable of

starting a social epidemic…• People with a special message that bring the world

together.• They stay connected – and know lots of people• They are Masters of the weak tie - a friendly or casual

social connection.• They manage to occupy many different worlds and

subcultures.• Acquaintances are their source of social influence.• Cohesiveness (social glue) helps spread the message.

Passing it on…

Addiction Carriers

Recovery Carriers

Spreading Recovery…• Addiction recovery is often caught before it is chosen—meaning that one

can get swept up in recovery in a process as unplanned and as irrational as how one got caught up in addiction.

• Recovery initiation is as much an interpersonal process as an intrapersonal process; increasing family and community recovery capital can have as much influence on recovery initiation as increasing intrapersonal recovery capital.

• Recovery carriers are people, usually in recovery, who make recovery infectious to those around them by their openness about their recovery experiences, their quality of life and character, and the compassion they exhibit for those still suffering.

Recovery Carriers (April, 2012)www.williamwhitepapers.com

Recovery Carriers in ROSCs• A central strategy for increasing community recovery

capital is increasing the density of recovery carriers.

• The density of recovery carriers exerts a profound influence on community recovery prevalence and incidence.

• Communities can take action to strategically increase the density of recovery carriers within the whole community, in particular neighborhoods, and across numerous social contexts in what we will call Recovery-Oriented Systems of Care (ROSC).

Defining Recovery-Oriented Systems of Care

Recovery-oriented systems of careare networks of formal and informal supports, opportunities, services and

relationships developed and mobilized to sustain long-term recovery for individuals and families.

The system in ROSC is not a treatment agency, but a macro level organization

of a social setting, community, state or nation.

Social Contexts for ROSCs• Recovery Community Organizations • Recovery Homes and Colonies• Recovery Schools• Recovery Industries & Employers• Recovery Ministries/Churches• Recovery Community Centers• Recovery Social Clubs• Recovery Cafes• Recovery Media• Recovery Entertainment venues• Recovery Celebrations and Events

Other (often neglected) attributes of the Recovery Equation

– Housing– Legal Assistance– Primary Health care; – Dental care; MH care– Employment – Banking; Credit Repair– Driver’s licenses– Education– Community Activism– Civic Participation (i.e., voting, volunteering, PTA)

What ROSCs can do…

• TRANSITION from a crisis-oriented, professionally directed, acute-care approach with its emphasis on isolated treatment episodes, to a recovery management approach that provides long-term supports and recognizes the many pathways to health and wellness.

• Provides a dynamic context, not so much for “relapse prevention”, but RECOVERY PROTECTION

• Make it DIFFICULT to fail at recovery

Examples of How ROSCs Care…

• Ensure that people get the care and support that they need to lead healthy and fulfilling lives• Embrace all pathways to recovery• Provide Networks of formal and informal services,

opportunities, supports and relationships• Create and Advocate for Policies that support the

ability of people to establish recovery and to sustain their recovery

• Enhanced Peer Recovery Support Services; Recovery Coaches; and Integrated Behavioral Healthcare

Best places for more information on ROSC

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www.facesandvoicesofrecovery.org

www.billwhitepapers.com

The Addiction Technology Transfer Center Networks

http://www.attcnetwork.org/index.asp

This year, New Mexico makes it’s move towards the cultivation of ROSC