Last week, a diverse group of recovery experts met on Capitol Hill to talk about their programs and the role of recovery support in the treatment continuum. The forum was part of the “Translating Science into Practice” series and was sponsored by the Addiction Policy Forum, the National Criminal Justice Association (NCJA) and Faces & Voices of Recovery (FAVOR).
Jessica Nickel, executive director of the Addiction Policy Forum, led off the Oct. 24 meeting by noting that the Comprehensive Addiction and Recovery Act, signed into law this summer, lays out the framework for including recovery support as a key tool in fighting addiction.
Many of the speakers introduced themselves as individuals in long-term recovery. Patty McCarthy Metcalf, executive director of Faces & Voices of Recovery, in recovery for more than 26 years, said that the people who provide peer-based recovery services are themselves in recovery. FAVOR supports “all pathways to recovery,” as does its Association of Recovery Community Organizations (ARCO). This includes medications, faith-based and “natural” recovery, she said. More than 100 organizations now belong to ARCO, said Metcalf.
Scott Strode, founder and executive director of Phoenix Multisport, helps people find recovery through physical activity. A recovering alcoholic, Strode learned that his problems started with trauma in childhood. “I was self-medicating the pain,” he said. And in his early 20s, he learned to “heal my self-esteem” by climbing to the top of a mountain. Phoenix Multisport welcomes “anybody who has 48 hours clean and sober,” and operates in four states. Participants have to adhere to a code of conduct, which Strode summed up as not allowing anything that is “not nurturing” into the program.
One theme that came up repeatedly was that recovery supports are not treatment. “We’re talking about nonclinical, community-based support,” said Metcalf. “This is very different from the organized treatment network that is out there.”
Some people go to Phoenix Multisport directly from formal treatment programs, said Strode. “Treatment is great; it’s one piece of the continuum,” he said. “But we have to help people to get sustained recovery, and acute care won’t solve that.”
Strode said there was a lack of funding going to recovery supports. “A huge river of funding is going into treatment,” he said. “And we see people relapse as they come out of formal treatment programs, so we started this.”
The naloxone-recovery link
One of the gaps in the treatment continuum revealed by opioid overdoses is that when someone is rescued by a dose of naloxone, they are frequently not interested in treatment, and lost to the health care system after discharge from the emergency department. Michelle Harter, manager of Anchor Recovery, based in Providence, Rhode Island, described her program, which includes many types of recovery support and is well-known for its link that helps patients rescued from opioid overdoses with naloxone (see ADAW, Oct. 26, 2015). Once patients decide to participate in recovery support, they are given access to the services, which include meetings (12-Step, SMART Recovery, special groups) as well as art therapy, social activities and more. “We help them get a driver’s license, get a job, get insurance on the ACA [Affordable Care Act],” she said. Based on the Connecticut Community for Addiction Recovery training module (see ADAW, Aug. 26, 2013), Anchor now employs 43 coaches and has two operating centers and two pop-up centers. There are also recovery supports offered in prisons through the Rhode Island Department of Corrections. “We’re trying to develop a career ladder so more and more coaches are available for recovery support,” she said. “It’s not just about detox and treatment; it’s about one day at a time.”
George O’Toole, a recovery coach with Anchor Recovery, described the program in which emergency departments call to request help after a patient comes in with an overdose. If the patient is interested, Anchor sends a coach. “We try to get them into recovery support,” said O’Toole. These calls can also be initiated by EMS, he said. “We’re aware that they’re not always interested in treatment,” said O’Toole of the overdose victims. “All they think of is that you just ruined their high.” But the coaches “give them something to think about,” he said. The next day, the coach follows up with a phone call. So far, 1,400 people rescued by naloxone have been contacted by Anchor in the past 29 months. Out of this number, 82 percent have been met with, many of whom continue to engage in recovery support services, he said.
Helping family members
At FAVOR Greenville in South Carolina, Executive Director Rich Jones focuses on family members. Of the more than 8,000 people enrolled, most are family members. “Put yourself in the shoes of parents,” he said. “Think about what it’s like to hear that your son or daughter is using heroin. It’s completely baffling — people don’t know where to go, who to talk to.”
The family member can’t get help “unless they want to go to a clinic and get diagnosed with something, or until their loved one gets bad enough to get into treatment,” he said.
At FAVOR Greenville, however, “you don’t have to have a diagnosis, and you don’t have to wait until it gets worse.”
Sixty-eight percent of the calls to FAVOR Greenville come from a family member, not the person with an addiction, said Jones. “This makes sense logically,” he said. “The family member is a willing customer.” But they want answers. “They do not want to be told to detach with love. The family member does not want to be told, ‘You’re sick too.’ They want to know how you can help.”
FAVOR Greenville helps by providing interventions, in some cases. Since they opened their doors three years ago, they have provided 328 interventions. Jones stressed that these interventions “are not what you see on A&E,” referring to the aggressive interventions on the cable reality series Intervention. “We don’t do the blueberry pie intervention, where they stop by Grandma’s house for a piece of blueberry pie and and everybody is there and reads a letter about how much you suck, and then they put you on a plane to Panama for rehab,” said Jones.
But the interventions do require staff time, said Jones. “Our interventions are collaborative,” said Jones. “They don’t look like interventions; they look more like question-and-answer sessions.” The goal is to “talk the person into going to a service,” he said. FAVOR Greenville has recently added an online process to help family members identify a team to help with interventions.
Criminal justice system
John Shinholser’s work with the McShin Foundation, which he founded with his wife the advocate Carol McDaid in 2004, focuses on helping people in the criminal justice system. He doesn’t understand why every courtroom in the country doesn’t have a referral program; in one small town in Virginia, he saved the Richmond jail $250,000 a year with his court referral program, he said.
He acknowledged that many people in jail belong in treatment instead. He did note that there is money in the system that keeps jails going, giving as an example a $1 billion signing bonus a small jail gets from agreeing to a seven-year phone contract with a service provider. (Telephone charges for inmates are exorbitant, prompting the FCC to set caps.) “Nobody wants to drive down recidivism when you have a machine like that,” he said. “But let’s listen and learn and change our system.”
McShin also goes into jails, giving the “message of hope” so they are started on recovery before they get out of jail. He took a film crew into the Chesterfield jail, showing how the program works.
Like other recovery speakers at the forum, Shinholser said he is open to any kind of pathway to recovery: “12-Step, Christian, secular, Smart recovery, Suboxone or Vivitrol, any pathway anybody wants to do.”
Elizabeth Pyke, director of government affairs for the NCJA, said that the “silos” separating criminal justice and health money are rigid, in states as in the federal government. But that may be easing up at the state level, allowing criminal justice and public health to work together, she said. “Because of the opioid crisis, there is a real willingness and energy at the state level around breaking down these silos, making sure that the agencies are talking to each other,” she said.
Metcalf cited the work of Alexandre Laudet, Ph.D. (not at the meeting), who serves as emeritus director of the Center for the Study of Addictions and Recovery at the National Development and Research Institutes Inc. and provides consultancy on recovery issues to private, state and federal agencies. Laudet’s research funded by the National Institutes of Health found that the key ingredients to recovery include safe and affordable housing, employment, and health and wellness. Recovery community organizations help people access these benefits, said Metcalf. “We help give people a sense of belonging, help them register to vote, to be part of the community, to get to the doctor,” she said.
We contacted Laudet after the briefing to get her comments, as she is one of the few researchers to look specifically at the development of recovery. “Historically, professional substance use treatment is designed to help clients initiate recovery, focusing primarily on the reduction or cessation of use,” Laudet told us. Her work has consistently emphasized the importance of identifying and implementing strategies to sustain recovery over time, as relapse tends to occur quickly after treatment in the absence of continuing support. “That’s where peer-driven support comes in, a model that has previously been applied to the management of other chronic conditions where behavior change must be sustained for remission to endure,” she said, likening the recovery from addiction to other diseases such as diabetes, asthma and depression.
Recovery supports were the focus of a Capitol Hill briefing last week.